Objective: Appendicitis scoring systems have been developed as a diagnostic tool to improve the decision-making process in patients with suspected appendicitis.The aim of the study was to compare the results of the Alvarado, The Pediatric Appendicitis Score, modified Pediatric Appendicitis Score, Lintula, and Tzanakis scoring systems in childhood appendicitis. We also aimed to see whether our rates of correct diagnosis and negative appendectomy could change, if we had made decisions using the scoring systems. Materials and Methods: The patients who underwent appendectomy because of suspected appendicitis between June 2019 and June 2020 were evaluated prospectively. The patients were divided into appendicitis and non-appendicitis groups according to histopathological findings. The obtained data were used to calculate the scores for the scoring systems and statistical analyses. Results: In the study, 141 patients were included. The negative appendectomy rate was 14.8%. The lowest negative appendectomy rate (6.38%) was obtained with the Lintula scoring system. Tzanakis scoring system had the highest accuracy rate (85.1%) compared to the other scoring systems. Conclusion: The present scoring systems may assist in establishing the diagnosis of appendicitis and reducing negative appendectomy rates. The Lintula scoring system has the lowest negative appendectomy rate due to its higher specificity compared to Alvarado, Pediatric Appendicitis Score, modified Pediatric Appendicitis Score, and Tzanakis scoring systems. Tzanakis scoring system has the highest accuracy rate in the diagnosis of appendicitis, and thus we believe that it may be used as an alternative scoring system for children.
Mesenteric cysts are rare lesions and they are usually asymptomatic. Acute abdomen caused by infection of cyst is a very rare complication. We present a child with mesenteric cyst who presented acute abdomen and was treated with total cystectomy. Although mesenteric cysts are usually asymptomatic, they may cause serious complications. So, even if they are asymptomatic and diagnosed incidentally, these cysts should be closely monitored and surgical treatment should be considered for large cysts.
Background: Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown.Purpose: We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists.Methods: The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed.Results: Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy.Conclusion: The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.
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