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Klin B, Zlotcavitch L, Lysyy O, Efrati Y, Abu-Kishk I. Complicated appendicitis wrongly diagnosed as nonspecific diarrhea: ways to decrease this continuous threat. Minerva Pediatr (Torino) 2023; 75:14-20. [PMID: 30021409 DOI: 10.23736/s2724-5276.18.04968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The diagnostic assessment of right lower quadrant pain in children and adolescents is still a challenge. The aim of this study was to analyze the cases of complicated appendicitis wrongly diagnosed as nonspecific diarrhea, and based on the information obtained suggest a clear and simple policy in order to decrease misdiagnosis in the future. METHODS Three groups of patients were analyzed: children who underwent appendectomy (group 1); those with gastroenteritis (group 2), and those who underwent appendectomy following hospitalization under the wrong diagnosis of gastroenteritis (group 3). RESULTS Group 3 presented a more prolonged and complicated clinical course, higher fever, diffuse abdominal pain, repeat vomiting, higher C-reactive protein values, longer surgery duration and recovery. CONCLUSIONS When the etiology of right lower quadrant abdominal pain is not immediately evident and associated with atypical diarrhea, high fever, repeat vomiting, and significantly increased CRP values, early surgical consultation is required. If the clinical findings are unclear, an abdominal US should be performed as soon as possible. A limited abdominal computed tomography scan CT should follow those cases not resolved by history, physical examination, blood tests, and abdominal ultrasound.
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Affiliation(s)
- Baruch Klin
- Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel - .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel -
| | | | - Oleg Lysyy
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Yigal Efrati
- Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ibrahim Abu-Kishk
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel
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Jimbo K, Ohtsuka Y, Kono T, Arai N, Kyoudo R, Hosoi K, Aoyagi Y, Kudo T, Asai N, Shimizu T. Ultrasonographic study of intestinal Doppler blood flow in infantile non-IgE-mediated gastrointestinal food allergy. Allergol Int 2019; 68:199-206. [PMID: 30249378 DOI: 10.1016/j.alit.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although non-IgE-mediated gastrointestinal food allergy has increased rapidly in Japan, a small number of reports has evaluated B-mode and Doppler ultrasonographic findings in the acute phase of infantile gastrointestinal milk allergy. The aim of the present study was to compare the diagnostic utility of ultrasonographic findings and laboratory allergic data in non-IgE-mediated infantile gastrointestinal milk allergy. METHODS Sixteen cases of active non-IgE-mediated infantile gastrointestinal milk allergy, diagnosed by food elimination tests and oral food challenge tests (OFCTs) (group A), 15 cases of acute viral gastroenteritis (AGE) (group B), and 15 controls (group C) were enrolled. 1) B-mode abdominal ultrasound findings, 2) laboratory allergic data including eosinophil counts (Eos), serum IgE, and the antigen-specific lymphocyte proliferation test (ALPT) against milk protein, and 3) vessel density (VD) indirectly quantified by gastrointestinal Doppler flow at jejunum, ileum, and sigmoid colonic mucosae were evaluated and compared among the groups. RESULTS In the small intestine, wall thickening, dilation, mesenteric thickening, and poor peristalsis were found in 100%, 62.5%, 93.7%, and 100%, respectively, in group A. Eos, IgE, ALPT, and VD were positive in 25.0%, 0%, 87.5%, and 100%, respectively, in group A. Small intestinal VD was significantly greater in group A than in groups B (jejunum p < .001; ileum p < .001) and C (jejunum p < .001; ileum p < .001), with no significant differences between groups B and C (jejunum: p = .74; ileum: p = .73). CONCLUSIONS Abdominal Doppler ultrasonography and small intestinal VD at symptomatic state can support the diagnosis and evaluation of non-IgE-mediated infantile gastrointestinal milk allergy with symptoms of vomiting, diarrhea, and failure to thrive.
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Mammas IN, Theodoridou M, Kramvis A, Thiagarajan P, Gardner S, Papaioannou G, Melidou A, Koutsaki M, Kostagianni G, Achtsidis V, Koutsaftiki C, Calachanis M, Zaravinos A, Greenough A, Spandidos DA. Paediatric Virology: A rapidly increasing educational challenge. Exp Ther Med 2017; 13:364-377. [PMID: 28352303 PMCID: PMC5348700 DOI: 10.3892/etm.2016.3997] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
The '2nd Workshop on Paediatric Virology', which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Maria Theodoridou
- 1st Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, Athens 11527, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's and Children's Health, Noble's Hospital, Douglas, Isle of Man IM4 4RJ, British Isles
| | - Sharryn Gardner
- Department of Children's Accident and Emergency, Southport and Ormskirk Hospital NHS Trust, Ormskirk L39 2AZ, UK
| | - Georgia Papaioannou
- Department of Paediatric Radiology, ‘Mitera’ Children's Hospital, Athens 15123, Greece
| | - Angeliki Melidou
- 2nd Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Koutsaki
- Paediatric Neurology Division, 3rd Department of Paediatrics, School of Medicine, University of Athens, ‘Attikon’ University Hospital, Athens 12462, Greece
| | - Georgia Kostagianni
- Department of Otorhinolaryngology - Head and Neck Surgery, ‘Triassio’ General Hospital, Elefsina 19200, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Truro, Cornwall TR1 3LQ, UK
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
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Abstract
OBJECTIVES Few methods exist to noninvasively study in vivo gastrointestinal motility in animal models of enteric infections. None have been used on mouse pups, which often display more severe symptoms during enteric infections than adult mice. This study sought to determine whether digital fluoroscopy could be used to evaluate gastrointestinal motility in mouse pups as well as adult mice. MATERIALS AND METHODS Fluoroscopic imaging studies were performed on normal 6- to 8-week-old adult mice and 12-day-old pups to develop protocols for evaluating gastric and intestinal wall movements and changes in stomach sizes. These protocols were then applied to evaluate motility in an established rotavirus mouse model. Imaging studies were performed on adult mice at 0, 2, and 4 days postinfection and on 12-day-old pups at 2 days postinfection. RESULTS Fluoroscopic studies revealed postnatal differences of gastric peristalsis and rates of intestinal contractions between normal mouse pups and adult mice. Studies of the rotavirus mouse model revealed that differences in gastric function occur between rotavirus-infected and control mouse pups, but no discernible difference occurs between infected and control adult mice. In contrast, there were no detectable differences in rates of intestinal wall movements between control pups with normal stools and infected pups with loose stools. CONCLUSIONS These results demonstrate that fluoroscopy can evaluate in vivo motility in mouse pups and by doing so provide findings that are clinically relevant to the study of enteric infections in young.
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Yamashita Y, Yuge K, Tanaka N, Maeda K, Yamakawa RI, Matsuyuki M, Fsujisawa T, Kimura A. Ultrasonography findings and symptoms in acute rotavirus gastroenteritis. Pediatr Int 2010; 52:590-3. [PMID: 20113420 DOI: 10.1111/j.1442-200x.2010.03088.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to better understand how clinical events in acute rotavirus gastroenteritis are depicted on ultrasonography. METHODS The relationship between abdominal ultrasonography and clinical course and symptoms was evaluated in 92 patients with acute rotavirus gastroenteritis (51 boys, 41 girls) with an average age of 30.7 ± 24.6 months. RESULTS Significant correlations were observed between ultrasonography score and duration of illness after ultrasonography (P = 0.0232). It was also interesting that ultrasonography findings (score: 3.1 ± 1.0 vs 3.6 ± 1.2; P = 0.0118), clinical symptoms (3.1 ± 1.7 score vs 3.8 ± 1.8 score, P = 0.0293), and duration of illness after ultrasonography (4.4 ± 1.4 days vs 3.8 ± 1.1 days, P = 0.0301) were significantly different between patients examined on ultrasonography < 1 day after illness onset (n = 50, but duration of illness after ultrasonography followed only in 42) and those examined ≥ 2 days after onset (n = 42, but duration of illness after ultrasonography followed only in 35). CONCLUSION The ability of abdominal ultrasonography to indicate severity of disease makes abdominal ultrasonography an important guide to therapy.
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STANDER NERISSA, WAGNER WENCKEM, GODDARD AMELIA, KIRBERGER ROBERTM. ULTRASONOGRAPHIC APPEARANCE OF CANINE PARVOVIRAL ENTERITIS IN PUPPIES. Vet Radiol Ultrasound 2010; 51:69-74. [DOI: 10.1111/j.1740-8261.2009.01625.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Johansen K, Hedlund KO, Zweygberg-Wirgart B, Bennet R. Complications attributable to rotavirus-induced diarrhoea in a Swedish paediatric population: Report from an 11-year surveillance. ACTA ACUST UNITED AC 2009; 40:958-64. [DOI: 10.1080/00365540802415509] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tajiri H, Kiyohara Y, Tanaka T, Etani Y, Mushiake S. Abnormal computed tomography findings among children with viral gastroenteritis and symptoms mimicking acute appendicitis. Pediatr Emerg Care 2008; 24:601-4. [PMID: 18703990 DOI: 10.1097/pec.0b013e3181850cc8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate computed tomography (CT) findings in pediatric patients with viral gastroenteritis who presented with clinical features of acute abdomen. PATIENTS AND METHODS During 2 seasons of viral gastroenteritis from 2005 to 2007, 302 children with acute gastrointestinal symptoms were admitted to our center for treatment of dehydration and associated complications. Stool specimens obtained from 130 of the 302 were tested for norovirus with the reverse transcriptase-polymerase chain reaction method. RESULTS Among the 130 patients, 44 tested positive for norovirus, 34 for rotavirus, and 1 for adenovirus. In the remaining 51, except one with Campylobacter jejuni, no viral or bacterial pathogen was detectable. An abdominal CT scan was performed in 4 patients with norovirus and in 1 with rotavirus for suspected acute abdomen including acute appendicitis. Computed tomography (CT) findings were similar among the 5 patients, including thickening of the bowel wall and fluid-filled bowel loops in the small intestine with no pathological findings in the stomach, appendix, or colon. CONCLUSIONS Anatomical changes in the small intestine were shown by CT in 5 children with viral gastroenteritis who presented with acute abdomen. These imaging features of viral gastroenteritis may be useful in differential diagnosis of acute abdomen to avoid unnecessary surgery.
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Affiliation(s)
- Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Sumiyoshi-ku, Osaka 558-8558 Japan.
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Abstract
Rotavirus is the most frequent virus found in childhood gastroenteritis. A rotavirus viremia is observed in 19 to 63 % of cases, for three days at the beginning of infection. Then, rotavirus can reach several organs as liver (hepatitis in 1/3 of case), nervous central system (2 % of encephalitis could be linked to rotavirus), or more infrequently mesenteric lymph nodes, lung or heart. However, the link between rotavirus and systemic manifestations has not been well established. Further studies are necessary to confirm the role of rotavirus in these organ's lesions.
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Affiliation(s)
- M Bellaiche
- Service de Gastro-entérologie, Nutrition et Mucoviscidose, Hôpital Robert Debré, 48 bd Sérurier 75019 Paris, France.
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Abstract
The molecular characterization of gastroenteritis viruses has led to advances both in our understanding of the pathogens themselves and in development of a new generation of diagnostics. In developing countries, gastroenteritis is a common cause of death in children under 5 years that can be linked to a wide variety of pathogens. In developed countries, while deaths from diarrhoea are less common, much illness leads to hospitalization or doctor visits. Much of the gastroenteritis in children is caused by viruses belonging to four distinct families: rotaviruses, caliciviruses, astroviruses and adenoviruses. Viral gastroenteritis occurs with two epidemiologic patterns, diarrhoea that is endemic in children and outbreaks that affect people of all ages. Rotavirus infection causes severe gastroenteritis, particularly in infants under six months of age.
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Tawil MI. Pediatric Emergencies: Non-traumatic Abdominal Emergencies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Huppertz HI, Soriano-Gabarró M, Grimprel E, Franco E, Mezner Z, Desselberger U, Smit Y, Wolleswinkel-van den Bosch J, De Vos B, Giaquinto C. Intussusception among young children in Europe. Pediatr Infect Dis J 2006; 25:S22-9. [PMID: 16397426 DOI: 10.1097/01.inf.0000197713.32880.46] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intussusception, a potentially lethal condition with poorly understood etiology, is the most common cause of acute intestinal obstruction in children younger than 5 years old. In some cases, the condition has been associated with administration of the first licensed rotavirus vaccine, the reassortant rhesus-human tetravalent rotavirus vaccine (RRV-TV; RotaShield). No such association has to date been reported from large phase III safety trials with new rotavirus vaccines. As 2 new, live-attenuated oral rotavirus vaccines are currently under review for approval by the European Union regulatory authorities, a review of the clinical, etiologic and epidemiologic aspects of intussusception in Europe is urgently needed. We conducted a review of Medline literature, published from 1995 onwards on intussusception in the World Health Organization's European Region. The results are compared with data from previous reviews and other regions. The classic triad of intussusception symptoms (abdominal pain, abdominal mass, bloody stools) was present in 29-33% of patients according to the medical literature reviewed. Conservative treatment (barium, air or saline enema) was the rule (81% of cases), and few complications were observed during treatment. Treatment outcome was generally favorable, with recurrence occurring in approximately 1 in 10 patients, and only 1 death reported. Structural lead points were seen in 3% of patients; no other reliable data on the etiology of intussusception were found. The incidence of acute intussusception in young children in Europe, according to 6 heterogeneous hospital-based studies, ranged from 0.66 to 2.24 per 1000 children in inpatient departments and from 0.75 to 1.00 per 1000 children in emergency departments. Peak incidences were found in children 3-9 months of age. There are still gaps in our knowledge of intussusception with respect to its etiology and especially by which mechanisms RRV-TV might have caused it to occur. Data from regions outside Europe showed that rotavirus infection and disease are not associated with intussusception. As new rotavirus vaccines become available for use in Europe, postlicensure surveillance for intussusception is indicated and may be instrumental in further understanding the epidemiology of this condition and in further assessing the safety of future vaccines.
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