Although a routine appendectomy is not required for a normal-looking appendix, in a case where the inflammatory status of the appendix adheres to the surface of the hernia sac, an appendectomy is required. We believe that USG examination in the diagnosis of Amyand's hernias can provide additional contribution.

Background:We aimed to compare the analgesia quality of caudal block of low volume, high concentration bupivacaine to the conventionally used volumes and concentrations of the drug in neonates undergoing circumcision with sole caudal anesthesia.Methods: Fifty neonates, undergoing circumcision were randomly assigned to low volume high concentration (group LVHC, n=25) and control groups (group C, n=25). Both groups received a caudal injection: Group LVHC 0.5 ml/kg bupivacaine 0.375% (1.875 mg/kg) and group C 1 ml/ kg bupivacaine 0.25% (2.5 mg/kg). Hemodynamic parameters, block onsets and analgesia periods were compared among the groups. Pain scores were evaluated hourly for 3 hours postoperatively with NIPS (neonatal infant pain score). Statistical analyses were performed with Student's t-test for continuous variables. X 2 and Mann-Whitney U-tests were used for nominal and/or categorical variables.Results: Demographic, hemodynamic data, block onset time (group LVHC and C values were 4.9 ± 1 vs 5.2 ± 2 mins, respectively; p=0.53) was similar and postoperative median NIPS (a median value of 0 at postoperative 1, 2, and 3. hours) were identical among the groups (p=0.7, p=0.9, p=1). None of the neonates required additional analgesic for the first 24 hours following the surgery; therefore postoperative analgesic requirement was similar among the groups (p>0.1). Conclusions:Low volume high concentration caudal bupivacaine provided a similar perioperative analgesia quality, time and safety profile compared to conventional bupivacaine doses in awake neonates undergoing circumcision. Low volume, high concentration bupivacaine may be used to reduce the risk of local anesthetic toxicity in outpatient neonates.

The addition of intranasal ketamine to oral midazolam significantly improved the quality of induction and reduced sevoflurane-induced emergence agitation, in children undergoing urological surgery.

We present a 13-year-old child who admitted with a dull right upper quadrant pain that started 3 weeks before her referral. Several medications were given but they did not change the intensity and the frequency of the pain. Her physical examination was nonspecific except for slight right upper quadrant tenderness. The imaging studies revealed a sewing pin perforating the stomach and gallbladder. The patient was treated with a successful operation, and no postoperative complications were observed. To our knowledge, this is the first case of a sharp foreign body gallbladder perforation in a child.

Introduction: We aimed to underline the importance of the covert comorbidities like ileal intestinal polyps in pediatric abdominal operations for appendicitis. Case: A 10-year-old girl was referred to us from the emergency ward with the complaints of abdominal pain and vomiting. After detailed examination, we decided to conduct an abdominal exploration in suspicion of potential acute appendicitis. During the laparotomy, an acute simple appendicitis was found and appendectomy was performed. We further explored the abdomen to rule out a possible Meckel diverticulitis, during which an ileal intraluminal mass was palpated about 10 cm proximal to the intestinal ileocecal valve. We performed enterotomy and resected the polypoid mass completely. The histopathological reports were lymphoid hyperplasia for the appendicitis and intestinal hyperplastic polyp for the polypoid mass. Follow up of the patient after 6 months was eventless. Conclusions: Comorbidities like intestinal polyps should be part of the considerations during the abdominal explorations for acute appendicitis. Missing an ileal polyp may lead to a second operation.

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Trauma either accidental or intentional isIn this review, the principles of first approach to the multiple trauma patient is discussed.

Cervical teratomas are rare tumors during the prenatal period. Cervical teratomas account for 1.5-5.5% of all pediatric teratomas. Both mortality and morbidity are significantly high because of airway obstruction due to a mass effect of the tumor although good results are achieved with total excision of the mass. Antenatal diagnosis by routine ultrasound (US) screening helps in preparing a team to provide airway support and surgery. We present two cases of cervical teratomas with total excision and cure and a postmortem study from our pathology laboratory. The third case, the female infant who died soon after birth, demonstrates the paramount importance of antenatal diagnosis.