The combination of congenital bilateral absence of the vas deferens and unilateral renal agenesis, without cystic fibrosis, is rare and not reported previously in the paediatric literature. These findings require appropriate counselling of the parents and child, with regards to the long-term implications of infertility and renal function.
The prompt diagnosis of appendicitis in children is made difficult not only by the challenging nature of a paediatric history and examination but also by the protean behaviour of the symptoms. We know that almost half of children will present with some atypical features of appendicitis and that one quarter will have primarily atypical features.1 However, delay in diagnosis correlates with an increased risk of perforation.2 In the uS this diagnostic challenge has resulted in appendicitis being the second most common diagnosis involved in paediatric emergency medicine malpractice claims, the most common being meningitis. Diagnostic error accounted for 39% of these claims.
3While we are still taught to consider appendicitis as a clinical diagnosis, over the past two decades ultrasonography and computed tomography (CT) have emerged as tools to assist in this diagnostic challenge. There has been much debate within the literature over which imaging modality is superior. [4][5][6] Graded compression sonography offers a rapid, non-invasive and inexpensive means of imaging an inflamed appendix. The examination can be performed at the site of greatest tenderness, enabling correlation of imaging findings with patient symptoms, and in this way it is dynamic. 7 For these reasons, within the uK, it has become the primary imaging modality in the diagnosis of acute appendicitis. Nevertheless, its role in the management of a child with acute abdominal pain varies between different institutions and its use extends beyond specialist paediatric centres. Given the operator-dependent nature of this imaging modality, it is essential that we audit departmental accuracy. However, few institutions have published such figures in the uK literature. [8][9][10] This study aims to demonstrate the value of ultrasonography as a tool in the decision-making process by providing the fundamental rates of negative appendicectomy and perforation for comparison and measures of the accuracy of ultrasonography for this regional unit.
MethodsThis was a cross-sectional retrospective study using three routine hospital databases. A search was performed on the theatre information database for appendicectomies and these were then matched with corresponding pathological reports on appendix specimens. The radiology information system returned a database of reports on abdominal ultra- Although regular clinical assessment of the acute abdomen is considered best practice, ultrasonography confirming the presence of appendicitis will add to the decision-making process. The aim of this study was to assess the accuracy of ultrasonography and its usefulness in diagnosing acute appendicitis in a regional paediatric surgical institution. METHODS Retrospectively and in this order, radiology, theatre and histopathology databases were searched for patients who had presented with acute abdominal pain, patients who had undergone an appendicectomy and all appendix specimens over a two-year period. The databases were cross-referenced against each other. RESULTS A total of 273 n...
Ultrasonography is used liberally to aid in the decision making process of equivocal and complicated cases of acute appendicitis and it achieves good measures of accuracy. As a diagnostic tool it is unique in its ability to positively predict as well as exclude. A high negative predictive value suggests that more patients could be managed on an outpatient basis following a negative scan.
A temporising stoma does not reduce the discrepancy in the calibre of the atretic ends in proximal colonic atresia. Right hemicolectomy and ileo-colic anastomosis should therefore be considered at the initial surgery.
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