Acute appendicitis presenting as chest pain

A Tale of Two Congenital Lesions: A Case Report of Congenital Diaphragmatic Hernia and Congenital Heart Disease Managed by Successful Surgical Outcome With Review of the Literature (Bhende-Pathak Hernia)

Congenital diaphragmatic hernia (CDH) is a diaphragmatic defect that is usually situated on the left side in the posterolateral region, named a Bochdalek hernia (BH), which allows abdominal organs to herniate into the thoracic cavity. BH is a prevalently observed birth anomaly in infants but is rare in adults. Right-sided BH that involves the colon is exceptionally rare, and no prior cases have described ileocecal appendix involvement. Here, we present a case of a preschooler with a right-sided BH and patent ductus arteriosus (PDA), requiring distinct surgical approaches: left open thoracotomy for PDA ligation and right open thoracotomy for CDH repair. Surgical intervention is associated with reduced morbidity and mortality, favorable long-term outcomes, and a low recurrence rate, irrespective of the selected approach. Reinforcement through suture repair with mesh application, as well as PDA ligation, reinforced with metallic clips as the preferred surgical operation in this case. To the best of our knowledge, this is the first reported instance of a pediatric patient with right-sided BH that involves the appendix, alongside concurrent congenital heart disease (CHD). We propose the term Bhende-Pathak hernia for this pediatric variant.

[Perforative appendicitis in the left-sided false diaphragmal hernia]

Abnormal localization of the appendix in hernial sac occurs in 2-4% of cases. Appendix is often found in inguinal and femoral hernias. Localization of the appendix in diaphragmatic hernia is described as a casuistic case. Case report of successful surgical treatment of a patient with perforated appendicitis in the left diaphragmatic hernia is presented.

Pediatric incidental appendectomy: a systematic review

Incidental appendectomy is the removal of the vermiform appendix accompanying another operation, without evidence of acute appendicitis. It is generally performed to eliminate the risk of future appendicitis. The risks and benefits of incidental appendectomy during various operations in children have been debated for over a century, but need to be revisited in light of innovations in medical practice, including minimally invasive surgery, improved imaging techniques, and use of the appendix as a tubular conduit for reconstruction. A detailed review was undertaken of the techniques, pathology, risks of appendectomy, utility of the appendix, and incidental appendectomy in the treatment of specific pediatric medical conditions. A comprehensive literature search was performed, and retrieved results were reviewed for relevance to the topic. The decision to perform a pediatric incidental appendectomy relies on informed consideration of the individual patient's co-morbid conditions, the indication for the initial operation, the future utility of the appendix, and the risk of future appendiceal pathology. The discussion includes a variety of situations and comorbid conditions that may influence a surgeon's decision to perform incidental appendectomy.

Ultrasonography (US) in the assessment of pediatric non traumatic gastrointestinal emergencies

Background

Non traumatic gastrointestinal emergencies in the children and neonatal patient is a dilemma for the radiologist in the emergencies room and they presenting characteristics ultrasound features on the longitudinal and axial axis. The most frequent emergencies are : appendicitis, intussusceptions, hypertrophic pyloric stenosis, volvulus due to intestinal malrotation. The aim of this article is to familiarize the reader with the US features.

Methods

A retrospective analysis of 200 ultrasound examinations performed in neonatal and children patients with fever, abdominal pain, leukocytosis, vomiting and diarrhea were evaluated.

Results

Of 200 exame 50 cases of intussusceptions, 100 cases of appendicitis, 20 cases associated with abscess;10 gangrenous appendicitis with absence a color Doppler , and 10 cases of perforated appendicitis at tomography computer integration and 10 cases of volvulus was found.

Conclusions

Ultrasonography (US) is therefore rapidly becoming an important imaging modality for the evaluation of acute abdominal pain, particularly in pediatric patients, where satisfactory examination is often not achievable for the attending clinicians. US provides excellent anatomic detail on the longitudinally and axial axis .

Intra-thoracic appendicitis in a child with Down's syndrome

Morgagni congenital diaphragmatic hernias are rare. They are associated with chromosomal anomalies, especially Down's syndrome. Acute appendicitis is the most common surgical emergency in childhood, but accurate diagnosis can be a challenge if encountered out of the usual anatomical position. This is the first case report of acute appendicitis within a Morgagni hernia in a child with Down's syndrome.