Piometra secundario a estenosis cervical en una adolescente / Pyometra secondary to cervical stenosis in an adolescent

INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.

INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.

Apendicitis versus dolor abdominal agudo inespecífico: evaluación del Pediatric Appendicitis Score / Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation

Introducción: El dolor abdominal agudo inespecífico es el principal proceso que requiere diagnóstico diferencial con la apendicitis en la práctica clínica. El objetivo de este estudio es evaluar la utilidad del Pediatric Appendicitis Score (Regla de predicción clínica de apendicitis pediátrica) para diferenciar estas 2 entidades. Material y métodos: Se evaluó prospectivamente a los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años, incorporando al estudio casos de dolor abdominal agudo inespecífico y apendicitis. Se recogieron diferentes variables, incluyendo las que conforman el Score y la proteína C reactiva, que se analizaron estadísticamente de manera descriptiva, univariante y multivariante, y mediante pruebas de rendimiento diagnóstico (curvas ROC). Resultados: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La temperatura y el dolor a palpación en fosa iliaca derecha fueron las únicas variables que no mostraron diferencias significativas entre los grupos, careciendo de poder de discriminación. El dolor con la tos, el salto y/o la percusión fue la variable con mayor asociación a apendicitis. El Score estratificó correctamente a los pacientes en grupos de riesgo. La sustitución de la temperatura por la proteína C reactiva en el Score aumentaba su rendimiento diagnóstico, aunque sin diferencias significativas. Conclusiones: El Pediatric Appendicitis Score ayuda en el diagnóstico diferencial entre apendicitis y dolor abdominal agudo inespecífico. Sería recomendable la sustitución de la temperatura en el Score, pues carece de poder de discriminación entre estos grupos. La proteína C reactiva, categorizada en el valor 25,5 mg/L, podría ser utilizada en su lugar (AU)

Introduction: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. Material and methods: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. Results: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. Conclusions: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5 mg/L value could be used instead (AU)

[Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation]. / Apendicitis versus dolor abdominal agudo inespecífico: evaluación del Pediatric Appendicitis Score.

INTRODUCTION: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. MATERIAL AND METHODS: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. RESULTS: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. CONCLUSIONS: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead.

Neonatal ascites and oligohydramnios: the role of kidney.

Posterior urethral valve pathologies are the most frequent childhood obstructive uropathy reported, and we infer their presence on diagnosing foetal ascites and oligohydramnios. Early action is vital to determine the long-term development and the degree of impairment of renal function. We report a newborn male 34 weeks of gestation with a prenatal diagnosis of foetal ascites, fluid on the loose in renal fossa and oligohydramnios. Subsequent studies have shown the presence of posterior urethral valves with associated significant vesicoureteral reflux. There was no secondary renal damage. Intrauterine decompression of the urinary tract seems to have exerted a protective role against kidney damage. This finding supports the role of foetal decompression surgery in early and severely obstructive forms to improve the prognosis of renal function in the long term.

Dermoid cyst of the spermatic cord in children.

Most of inguinal masses in children correspond to inguinal indirect hernias, but other pathologic entities may be found. Dermoid cysts of the spermatic cord are very rare, with only 9 clear cases reported in the literature to date, all of them in adults. We present a case of dermoid cyst of the spermatic cord in a 2-year-old boy, the youngest patient reported so far. Dermoid cysts of the spermatic cord should be considered as part of the differential diagnosis of inguinal masses in children, especially in cases of long-standing, nontender, and irreducible inguinal mass.