BackgroundTo determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.MethodsA prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.ResultsOf the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients.ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.

Background: Splenic cysts are one of the relatively rare conditions in pediatric surgery practice. Primary non-parasitic splenic cysts are even more scarce. Case presentation: A 13-years-old female patient presented with chronic left hypochondrial pain of 2 months duration. Abdominal ultrasonography and computed tomography revealed huge 18 cm × 14 cm × 10 cm splenic cyst. Deroofing of the cyst was done which was complicated by secondary infection. Subsequently, the patient was re-operated on and partial splenectomy done with good outcome at 6 months follow up. Conclusion: Partial splenectomy is the best management strategy for huge non-parasitic splenic cysts in children. There is also less recurrence rate of splenic cysts with preservation of splenic functions.

A 7-year-old female child was presented to the emergency room with acute abdominal pain and vaginal bleeding. Her assessment revealed a firm large lower abdominal mass with evidence of precocious puberty with bilaterally symmetrically enlarged breast (Tanner stage B4-P1-A1). Abdominal imaging showed a well-defined soft midline pelvi-abdominal single mass measuring 7.0×12.6×11.7 cms with no ascites. Serum tumour markers including lactate dehydrogenase (LDH), beta-subunit of human chorionic gonadotropin (B-hCG) and luteinizing hormone/follicular stimulating hormone (LH/FSH) were all normal. At operation, there was a huge abdominal tumour weighing 558 grams, localized to the right ovary sparing the left ovary, uterus, lymph nodes and other abdominal organs. Unilateral right salpingo-oophorectomy was performed. Histopathologic examination revealed ovarian dysgerminoma with intact capsule; FIGO Ia. Immunohistochemical stainings were positive for placental alkaline phosphatase (PALP), CD 117(c-kit) and calretinin focally but was negative for cancer antigen-125 (CA-125), B-hCG, S-100, carcinoembryonic antigen (CEA), and leukocyte common antigen (LCA). Being fitting in the low risk classification, the wait and see protocol was selected with strict follow-up with pediatric oncologist and pediatric surgeon. Along the duration of 2 years follow up, there was no more vaginal bleeding with dramatic reduction of the breast size and no recurrence.

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