Recurrent inflammatory pseudotumors in children

BACKGROUND/PURPOSE

pulmonary (PPT) and extrapulmonary pseudotumors (EPPT) are uncommon benign tumors, which, in general, do not recur after complete resection. Recurrence rates for both types of pseudotumors are undocumented in a large population of children, and the salient features of potential recurrences are unspecified.

METHODS

This is a report of 15 children with PPT and EPPT; 3 children had a recurrence. These pseudotumors recurred despite adequate primary resection of all gross disease at first presentation. The literature was reviewed to determine rate of recurrence for PPT and EPPT and also to document features common to recurrent pseudotumors.

RESULTS

Overall recurrence rate for pseudotumors was 14%. PPT and EPPT, which were not confined to a single organ, had a high chance of recurrence (46% and 30%, respectively) compared with PPT and EPPT, which were confined to a single organ (1.5% and 8%, respectively). Recurrences have appeared between 3 months and 7 years. Intraabdominal EPPT accounts for more than 75% of the EPPT recurrences.

CONCLUSIONS

PPT and EPPT recur more frequently than anticipated. All pseudotumors, which on initial presentation extend beyond the confines of a single organ, have a high chance of recurrence despite what appears to be adequate resection. Children with pseudotumors that extend beyond a single organ, require frequent postoperative evaluation for recurrence and may be candidates for chemotherapy or radiotherapy at the time of initial resection.

Laparoscopic versus open appendectomy: a prospective comparative study of 227 patients

BACKGROUND

Although laparoscopic appendectomy is widely practiced in developed countries, still there are many questions regarding the advantages and disadvantages of this approach in the treatment of acute appendicitis. Several controlled trials have been conducted, some in favor of laparoscopic appendectomy others not. The aim of this study was to evaluate laparoscopic appendectomy in comparison with open appendectomy, with special emphasis on postoperative septic complications.

METHODS

For this study, 227 consecutive patients (159 males and 68 females) with a diagnosis of suspected appendicitis between 1995 and 1999 were assigned either to laparoscopic appendectomy (n = 108) or open appendectomy (n = 119). The patients were assigned according to insurance company approval and patient preference. There were no exclusion criteria and no age limits in this study.

RESULTS

Wound infection was significantly higher in the open group (incidence, 7.6%) than in the laparoscopic group (incidence, 0%; p <0.003). Intraabdominal infections were equal in both groups. Hospital stay was significantly shorter in the laparoscopic group (p <0.046), but operative time was little longer than in the open group (p <0.002). Conversion to open surgery was necessary in one case.

CONCLUSIONS

Laparoscopic appendectomy is as safe and effective as the open procedure. It significantly reduces the rate of postoperative wound infection. However, it is still acceptable to perform the open procedure, especially in hospitals without a large amount of laparoscopic experience.

An unusual abdominal mass in a renal transplant recipient

Renal transplant recipients are at increased risk of malignancy and infection. We present the case of a 72-year-old-man with recurrent bladder carcinoma, abdominal aortic aneurysm repair, and end-stage renal failure due to renovascular disease. He received a cadaveric renal allograft into his left iliac fossa, was given cyclosporin A, azathioprine, and prednisolone triple therapy immunosuppression, and had no rejection episodes. He presented four years post-transplantation with a two-year history of intermittent sweats and fevers. Previous episodes had been investigated with no firm diagnosis made. This time he had right iliac fossa pain of three weeks' duration. Examination revealed a tender mass. Investigations showed unchanged graft function, but elevated inflammatory indices. Ultrasonography and computed tomography detailed an infiltrating mass associated with the sigmoid colon, which colonoscopy failed to visualise. At laparotomy a 6-cm tumor was removed, with adherent sigmoid colon and bladder dome. Macroscopically the mass was an abscess, and microscopy found acute and chronic inflammatory giant cells and fibrillary masses suggestive of actinomycosis, with no malignancy. The patient recovered uneventfully on antibiotics. At six months' follow-up, examination, inflammatory markers, and radiographic imaging showed no evidence of recurrence. Twelve months later the patient died of rupture of his proximal abdominal aorta. There was no evidence of recurrence at postmortem examination. We conclude with a brief review of actinomycosis in transplant recipients.