Key words: Acute appendicitis, Transumelical laparoscopic approach, Case series, Children
Background - Acute appendicitis is a flogistic process that is often observed in the paediatric population. The reason could be found in the over activity of the lymphatic tissue against inflammatory agents. The experience of the Paediatric Surgery Unit in Rimini (Italy) in the treatment of acute appendicitis using the transumbilical laparoscopic assisted approach (TULAA) is reported. Material and Methods -In the last 9 years, 722 children affected by acute appendicitis have been treated in the Unit using the single port access. A Hasson trocar is positioned through the umbilicus and an operative instrument is inserted through the trocar inside the abdominal cavity. Once identified, the appendix is exteriorized through the umbilicus and a traditional appendectomy is performed. Results - Out of 722 appendectomies performed, 2.7% were normal appendix (no inflammatory process in pathologic diagnosis), 17.7% were catarrhalis, 47.8% phlegmonous and 31.8% complicated appendicitis. In the last group it was necessary to widen the surgical umbilical incision of about 1-2 cm. In 3 cases (0.4%) a surgical conversion was necessary due to a reduced mobility of the appendix and caecum. Discussion - The TULAA procedure actually represents an easy and feasible technique that well combines the laparoscopic advantages with the open surgery features and excellent cosmetic results.
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Pagine elettroniche
Un’appendicite di troppo
Elisa Zanelli, Stefania Crocco
Clinica Pediatrica, , IRCCS Materno-Infantile “Burlo Garofolo”, Università di Trieste
Key words: Stump appendicitis, Complications, Case report
Stump appendicitis is the re-inflammation of the residual appendiceal tissue after an appendectomy. It is a rare and unknown complication of appendectomy.
Clinical features of stump appendicitis do not differ from acute appendicitis, even though the history of a previous appendectomy can be misleading causing a delayed diagnosis. Ultrasonography can be useful in identifying inflammatory changes. The abdominal CT is reported as the gold standard for its diagnosis. Stump appendicitis has a higher risk of complications than appendicitis, with perforation being reported in nearly 70% of the cases. Stump appendicitis should be considered in all patients who have previously undergone appendectomy and have had a convincing history of acute appendicitis. Treatment by re-surgery and complete removal of the appendix will resolve the case.
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Pagine elettroniche
Una bambina che cresce poco con strane macchie blu sulla lingua
Vera Ettari,
Mariavalentina Catania, Roberto Barcellona
U.O. Pediatria e Neonatologia P. O. Sciacca, ASP 1, Agrigento
A girl who does not grow and has strange blue spots on her tongue
Key words: Blue tongue, Recurrent candidiasis, Delayed growth
The case of a girl with a strange blue colour on her tongue (and not only) is the opportunity to present, in a tale-like style (narrative medicine), the way that enables to make a diagnosis of a rare disease. In this case the diagnostic reasoning has its two typical features: non-analytic (intuitive, unconscious) reasoning and analytic (hypothetical-deductive, rational) reasoning that require study and bibliographic research techniques.
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