Impact of the Coronavirus (COVID-19) Pandemic on the Care of Pediatric Acute Appendicitis

2021 ◽  
pp. 000313482110679
Author(s):  
William T. Head ◽  
Raphael H Parrado ◽  
Robert A Cina
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Viral Transmission ◽  
Delayed Presentation ◽  
Single Institution ◽  
Retrospective Assessment ◽  
Hospital Patients ◽  
Hospital Stays

Background Appendicitis is the most common abdominal surgical emergency in children. With the rise of the Coronavirus-19 pandemic, quarantine measures have been enforced to limit the viral transmission of this disease. The purpose of this study was to identify differences in the clinical presentation and outcomes of pediatric acute appendicitis during the Coronavirus-19 pandemic. Methods A single-institution retrospective assessment of all pediatric patients (<18 years old) with acute appendicitis from December 2019 to June 2020 was performed at a tertiary care children’s hospital. Patients were divided into two groups: (1) the Pre-COVID group presented on or before March 15, 2020, and (2) the COVID group presented after March 15, 2020. Demographic, preoperative, and clinical outcomes data were analyzed. Results 45 patients were included with a median age of 13 years [IQR 9.9 - 16.2] and 35 males (78%). 28 patients were in the Pre-COVID group (62%) and 17 in the COVID group (38%). There were no differences in demographics or use of diagnostic imaging. The COVID group did have a significantly delayed presentation from symptom onset (36 vs 24 hours, P < .05), higher Pediatric Appendicitis Scores (8 vs 6, P = .003), and longer hospital stays (2.2 vs 1.3 days, P = .04). There were no significant differences for rates of re-admission, re-operation, surgical site infection, perforation, or abscess formation. Conclusion During the Coronavirus-19 pandemic, the incidence of pediatric acute appendicitis was approximately 40% lower. These children presented in a delayed fashion with longer hospital stays. No differences were noted for postoperative complications.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation

2021 ◽  
pp. 135910452110481
Author(s):  
Katelynn E Boerner ◽  
Jennifer S Coelho ◽  
Fiza Syal ◽  
Deepika Bajaj ◽  
Natalie Finner ◽  
...  
Keyword(s):  
Food Intake ◽  
Somatic Symptom ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Lower Percentage ◽  
Liaison Psychiatry ◽  
Medical Diagnoses ◽  
Gi Symptoms

Certain presentations of Avoidant/Restrictive Food Intake Disorder (ARFID) and Somatic Symptom and Related Disorders (SSRDs) have conceptual overlap, namely, distress and impairment related to a physical symptom. This study compared characteristics of pediatric patients diagnosed with ARFID to those with gastrointestinal (GI)-related SSRD. A 5-year retrospective chart review at a tertiary care pediatric hospital comparing assessment data of patients with a diagnosis of ARFID ( n = 62; 69% girls, Mage = 14.08 years) or a GI-related SSRD ( n = 37; 68% girls, Mage = 14.25 years). Patients diagnosed with ARFID had a significantly lower percentage of median BMI than those with GI-related SSRD. Patients diagnosed with ARFID were most often assessed in the Eating Disorders Program, whereas patients diagnosed with an SSRD were most often assessed by Consultation-Liaison Psychiatry. Groups did not differ on demographics, psychiatric diagnoses, illness duration, or pre-assessment services/medications. GI symptoms were common across groups. Patients diagnosed with an SSRD had more co-occurring medical diagnoses. A subset (16%) of patients reported symptoms consistent with both diagnoses. Overlap is observed in the clinical presentation of pediatric patients diagnosed with ARFID or GI-related SSRD. Some group differences emerged, including anthropometric measurements and co-occurring medical conditions. Findings may inform diagnostic classification and treatment approach.

scholarly journals Clinicopathological correlation of acute appendicitis undergoing emergency appendicectomy in a tertiary care hospital of Gujarat: a retrospective study

2019 ◽  
Vol 6 (9) ◽  
pp. 3201
Author(s):  
Mrugesh Chudasama ◽  
Pallav Patel
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Vermiform Appendix ◽  
Study Patient ◽  
Care Hospital ◽  
Delayed Presentation ◽  
Operative Findings

Background: Acute appendicitis is acute inflammation and infection of the vermiform appendix, which is most commonly referred to simply as the appendix. The aim of this study was to determine the presenting pattern of acute appendicitis and to review the pathological diagnosis.Methods: This retrospective study was conducted in the general surgery department at tertiary care institute of Gujarat for the period of one year. One hundred patients who were attending department of surgery diagnosed as acute appendicitis were selected for the study. Patient demographics, clinical features, operative findings and histology results were recorded on a special patient proforma.Results: The most common presenting complaints were abdominal pain (n=100), nausea (n=54), vomiting (n=80) and diarrhoea (n=7). As for clinical signs 100% of the patients in this study had some degree of right iliac fossa tenderness. Open appendicectomy was performed in 62% of the patients and laparoscopic appendicectomy in 38% of the patients. 66% of the patients presented within 24 hours of the onset of symptoms whereas 28% presented 24-48 hours after the onset of symptoms.Conclusions: Diagnosis of acute appendicitis obvious based on strongly positive clinical presentation. Present study shows that acute appendicitis in India is a disease of young males. On further sub-classification of acute appendicitis, uncomplicated acute appendicitis seems to be the most common. Delayed presentation is associated with greater morbidity. 

scholarly journals A histopathological study of unusual findings in appendectomy specimens in a tertiary care hospital of Andhra Pradesh

2021 ◽  
Vol 6 (4) ◽  
pp. 291-294
Author(s):  
Suneetha Kona ◽  
Srinivasulu Kande ◽  
Boddu Penchala Prasanna ◽  
Sushma Chandulee Kancharla
Keyword(s):  
Acute Appendicitis ◽  
Andhra Pradesh ◽  
Carcinoid Tumour ◽  
Tertiary Care ◽  
Histopathological Study ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Medical College ◽  
Retrospective Assessment ◽  
Inflammatory Bowel

Acute appendicitis is sudden inflammation of the appendix, usually initiated by obstruction of the lumen. This results in invasion of the appendix wall by gut flora, and it becomes inflamed and infected.: To investigate retrospectivelythe prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis.This is retrospective assessment of hospital records of 150 patients who were diagnosed as acute appendicitis and underwent appendicectomy during March 2018 to February 2020 at Government Medical College, Bhagya Nagar, Ongole, Andhra Pradesh .Data of the patients were assessed based on age, sex, histopathological diagnosis, coexisting pathologies and uncommon findings on histology. According to histopathology report, negative for acute appendicitis were noted in 82 cases (55%), whereas positive for acute appendicitis in 68 cases (45.3%) . Rare findings were foundin 38 (55.8%) cases out of 68 cases. Parasites were found in 7 (18.4%) (Enterobius Vermicularis, Balantidum Coli, Schistosoma Haematobium), Mucocele in 12 (32%), carcinoid tumour in 8(21%), B cell malignant lymphoma in 2 (5%), leiomyoma in 2 (5%), Primary appendiceal adenocarcinoma in 3 (8%), Acute appendicitis with dysplastic changes in 2 (5%) and inflammatory bowel polyp was reported in remaining two cases(5%).: Even though unusualpathologies can be seen rarely during appendectomy, this should be kept in mind for further evaluation of each cases.

scholarly journals Torsion of cecal appendix. Report of the first Italian case and review of the literature

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Salvatore Fabio Chiarenza ◽  
Lorenzo Costa ◽  
Cosimo Bleve
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Rare Condition ◽  
Vermiform Appendix ◽  
Lower Quadrant ◽  
Italian Case ◽  
Right Lower Quadrant

In pediatric patients appendicitis is the most common cause of abdominal pain and surgery. Torsion of vermiform appendix is a rare cause, clinically indistinguishable from appendicitis with usually an intraoperative diagnosis. The first description of vermiform appendix torsion was made by Payne in 1918. Clinical presentation is similar to acute appendicitis. Preoperative investigations play a minimal role. Etiology of this condition is unclear, but is possible to distinguish a primary and a secondary torsion. We report a case of 5-years-old boy who presented with right lower quadrant abdominal pain. His clinical signs, symptoms and investigations mimicked an acute appendicitis. Intraoperatively we found a 720° appendix torsion on its base with its mesentery rotated in counter-clockwise direction. The appendix was gangrenous in appearance. A video-assisted trans-umbilical appendectomy was performed. We describe clinical presentation and management of this rare condition reviewing the literature.

Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland

2021 ◽  
pp. emermed-2020-209914
Author(s):  
Lauri Laukkanen ◽  
Sanna Lahtinen ◽  
Lasse Raatiniemi ◽  
Ari Ehrola ◽  
Timo Kaakinen ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hospital Admission ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
University Hospital ◽  
Emergency Department Admission ◽  
Emergency Medical ◽  
Hospital Patients

ObjectivesA high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.MethodsData from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.ResultsA total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.ConclusionIn this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.

scholarly journals Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

2019 ◽  
Vol 6 (12) ◽  
pp. 4318 ◽  
Author(s):  
Puneet Agrawal ◽  
M. Zaid Imbisat
Keyword(s):  
Retrospective Study ◽  
Typhoid Fever ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Delayed Presentation ◽  
Tertiary Care Centre ◽  
Ileal Perforation ◽  
Perforation Peritonitis

Background: Typhoid fever is one of major causes of intestinal perforation in India and is one of the common surgical emergencies for which intervention is required. The study aims to evaluate the clinical presentation, operative findings, outcome of surgical procedures, postoperative complications and associated mortality among the patients managed for typhoid ileal perforation in a tertiary care hospital.Methods: This was a retrospective study evaluating the patients who were operated for typhoid ileal perforation peritonitis in FH Medical College, Agra, UP, India between April 2017 and September 2019. Diagnosis of typhoid ileal perforation was made with the combination of clinical presentation, laboratory investigations, radiological results and per-operative findings.Results: In the present study, 57 patients were managed for typhoid ileal perforation. Majority of the patients were young. In our study 40 patients (70.18%) were male and 17 patients (29.82%) were female. All patients presented with pain in abdomen and abdominal distension. However there was no history of fever in 19.3% of patients. Free gas under the right diaphragm was present in 60% of patients. Exploratory laparotomy was done in all the patients and multiple perforations were found in 59.65% of patients. Ileostomy was made in 75% of patients. Most common post-operative complication was wound infection (85.96%) and mortality was 12.28%.Conclusions: Perforation peritonitis is an alarming complication of typhoid fever which needs urgent and aggressive management. Mortality rate is high (12.28%) and may be attributed to delayed presentation.

scholarly journals Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic

2020 ◽  
Author(s):  
Claire D. Gerall ◽  
Jennifer R. DeFazio ◽  
Anastasia M. Kahan ◽  
Weijia Fan ◽  
Erica M. Fallon ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Patients ◽  
Delayed Presentation ◽  
Optimal Outcomes

scholarly journals 1492. Comparison of Acute Cholangitis in Patients With or Without Cancer

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S543-S544
Author(s):  
Aurélien Sokal ◽  
Sylvain Chawki ◽  
Yann Nguyen ◽  
Alain Sauvanet ◽  
Philippe Ponsot ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Tertiary Care ◽  
Acute Cholangitis ◽  
Care Hospital ◽  
Reactive Protein ◽  
Cancer Management ◽  
History Of ◽  
Hospital Stays ◽  
Student’S T ◽  
History Of Cancer

Abstract Background Cancer-associated acute cholangitis (CAAC) are becoming more frequent and their characteristics may be changing with the evolution of cancer management. Our aim was to compare clinical, microbiological and outcome characteristics of CAAC to those of cancer-free acute cholangitis (CFAC). Methods All consecutive cases of acute cholangitis (AC) from November 2015 to March 2017 were collected retrospectively in a single tertiary care hospital in Clichy, France, specialized in gastroenterology. Hospital stays referred as AC by coding were screened. Patients fulfilling the 2018 Tokyo Guidelines diagnostic criteria for definite AC were included. Data were collected using a standardized form. CAAC were defined as AC that occurred in patients who had active cancer or history of cancer in the five previous years. CFAC were defined as AC in patient who no history of cancer, or in remission for more than 5 years. Comparison was made using Fisher or Student’s t-test. P < 0.05 was considered as significant. Results 156 episodes of AC in 130 patients were analyzed. 101 had CAAC and 55 had CFAC. Age and sex did not differ (table 1), but CAAC had a higher Charlson’s comorbidity index (4.4 vs. 1.7, P < 0.0001). Despite similar clinical presentation, CAAC had more pronounced cholestasis (Gamma GT 659 vs. 391UI/L; Alkaline phosphatases 526 vs. 309 UI/L; P < 0.0001 for both) and C-reactive protein level (133 vs. 97mg/L, P = 0.008, Table 2). E. coli was more common in CFAC (72.4% vs. 54% of positive blood cultures, P = 0.004). In bile cultures, Enterococci and multi-drug-resistant Gram negatives tended to be more frequent in CAAC than in CFAC (63 vs. 17%, P = 0.07 and 9.1% vs. 4.1%, P = 0.33, Table 2), respectively. CAAC more frequently required drainage (86.1% of cases vs. 43.6% in CFAC (P < 0.0001), including radiological drainage (42.5% vs. 12.5%; P = 0.008) and with multiple sessions (28.7% vs. 8.3%, P < 0.0001, Table 3). Antibiotherapy duration did not differ between the two groups. Despite similar initial severity, only 51.5% of patients with CAAC were alive, without febrile recurrence or other biliary drainage at day 28, vs. 85.5% of patients with CFAC (P < 0.0001, Table 3). Conclusion Despite comparable initial clinical presentation, management is more complex and outcome less favorable in CAAC vs. CFAC. Disclosures All authors: No reported disclosures.

scholarly journals Clinico-epidemiological profile of congenital heart disease in a tertiary care center – a retrospective descriptive study

2020 ◽  
Vol 7 (7) ◽  
pp. 326-330
Author(s):  
Dr. Pramila Ramawat ◽  
◽  
Dr. Nilesh Jain ◽  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Care Center ◽  
Tertiary Care ◽  
Central India ◽  
Mortality And Morbidity ◽  
Epidemiological Profile

Aims and objective: To study the clinical-epidemiological profile of congenital heart disease inhospitalized children. Material and methods: A retrospective study was planned in a tertiary carecenter in Central India. Children between ages 1 month to 14 years with CHD were included in thisstudy. Type of CHD, clinical presentation, anthropometry, demographic profile, and the outcome wasrecorded. Result: A total of 65 patients were included in the study. 43 patients were suffering fromacyanotic CHD and 22 were having cyanotic CHD. Most of the children admitted were below 1 yearof age (n-67%). Males (42) were more reported in the present study than females (23).Conclusion: CHDs are one of the commonest birth defects, timely diagnosis and intervention arevery important to decrease mortality and morbidity in pediatric patients.

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