Anastomotic Ulcers: Current Understanding of the Pathogenesis and Management.

PURPOSE OF REVIEW: Anastomotic ulceration following intestinal resection is an under- recognized problem in pediatrics. We discuss the relevant literature regarding this condition. RECENT FINDINGS: Anastomotic Ulceration following intestinal resection is a potentially life threatening cause of refractory anemia. Evaluation should include correction of micronutrient deficiencies and endoscopic evaluation by upper and lower endoscopy and small intestinal endoscopy if necessary. Initial treatment by medical therapy may consist of anti-inflammatory agents as well as antibiotics to treat small intestinal bacterial overgrowth. Surgical resection should be considered if refractory to treatment. Anastomotic ulcers in pediatric patients with small bowel resection should be considered as a cause of refractory iron deficiency anemia. Endoscopic evaluation should be undertaken to look for evidence of anastomotic ulcers. Surgical resection should be considered if medical therapy fails.

Plasma next-generation sequencing for diagnosis of amebic liver abscess in a non-endemic area.

Amebic liver abscess (ALA) is a common condition in the developing world but is rare in the United States without a clear exposure risk. It is even less common to develop in an infant. The diagnosis of ALA can be logistically difficult and often requires invasive procedures and testing with slow turnaround times. We present an 18-month-old boy initially admitted with fever, abdominal pain, and diarrhea with rapid progression to respiratory failure. He was found to have a significant pleural effusion accompanying a large solitary liver lesion with abdominal ascites. There was no infectious exposure history or travel history, and thus pyogenic liver abscess was suspected, and aspiration performed while he was on empiric antimicrobials. The bacterial culture was negative. Molecular testing with 16 s and 18 s rRNA PCR on the fluid were non-diagnostic. The diagnosis of Entamoeba histolytica was confirmed within 48 hrs via plasma next-generation sequencing. Serum IgG for E histolytica resulted positive multiple weeks after the patient was discharged. The patient made a full recovery after metronidazole and paromomycin. This case illustrates the need to maintain ALA in the differential diagnosis for liver abscess in an infant even in the absence of risk factors. Additionally, plasma next-generation sequencing may play a role in more rapid diagnosis of ALA and has the potential to reduce the need for more invasive testing.

Health Disparities in the Hospitalized Child.

Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.