A warning: don't be stumped by stump appendicitis.

When an emergency medicine physician evaluates a child with abdominal pain and a history of appendectomy, appendicitis is often excluded from the differential. We present a case of a 16-year-old boy who developed stump appendicitis 3 years after laparoscopic appendectomy. Knowledge of this rare phenomenon in children can lead to timely diagnosis and avoid the significant additional morbidity associated with perforation of the stump.

Splenic conservation: variation between pediatric and adult trauma centers.

Objectives: Nonoperative management of hemodynamically stable children and adolescents with splenic injury regardless of grade has become standard; however, numerous studies have shown a wide variation in management. We compared the treatment and outcomes of adolescent splenic injuries in our region, which includes a pediatric level I trauma center (PTC) and an adult level I trauma center (ATC).

Methods: A retrospective review of the trauma registry was performed on patients 14 to 17 y old with blunt splenic injury admitted to either the local PTC or ATC from January 1999 through December 2010.

Are facilities following best practices of pediatric abdominal CT scans?

Background: Established guidelines for pediatric abdominal CT scans include reduced radiation dosage to minimize cancer risk and the use of intravenous (IV) contrast to obtain the highest-quality diagnostic images. We wish to determine if these practices are being used at nonpediatric facilities that transfer children to a pediatric facility.

Methods: Children transferred to a tertiary pediatric facility over a 16-mo period with abdominal CT scans performed for evaluation of possible appendicitis were retrospectively reviewed for demographics, diagnosis, radiation dosage, CT contrast use, and scan quality.

Computed tomography scanning in pediatric trauma: opportunities for performance improvement and radiation safety.

Background: Recently, pediatric CT scanning protocols have reduced radiation exposure in children. Because evaluation with CT scan after trauma contributes to significant radiation exposure, we reviewed the CT scans in children at both initial presentation at a non-pediatric facility and subsequent transfer to a level I pediatric trauma center (PTC) to determine the number of scans, body area scanned, radiation dosage, and proportion of scans at each facility.

Methods: The trauma database was retrospectively reviewed for children aged 0 to 17 y initially evaluated for trauma at another facility and then transferred to our PTC for pediatric specialty care between January 2000 and December 2010.

A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon.

Purpose: Meconium ileus (MI) is the earliest clinical manifestation of cystic fibrosis (CF), occurring in up to 20% of patients with CF. Our aim was to review and integrate current knowledge about the diagnosis and management of fetuses and neonates with MI that may aid the pediatric surgeon in caring for these patients.

Methods: We identified areas of interest including pathophysiology, prenatal diagnosis, nonoperative and operative management, postoperative management, and prognosis.

Dog attack resulting in evisceration in an infant.

Severe dog bites can result in substantial morbidity and potentially fatal injury. We present a case of an infant attacked by a Staffordshire bull terrier with resultant soft tissue injury, evisceration, and bowel injury. Rapid assessment in the emergency department included evaluation for both blunt and penetrating injuries.

Late administration of antenatal vitamin A promotes pulmonary structural maturation and improves ventilation in the lamb model of congenital diaphragmatic hernia.

Purpose: The lungs in congenital diaphragmatic hernia (CDH) are hypoplastic and immature making respiratory support one of the most challenging aspects of caring for these neonates. Vitamin A is essential for normal lung growth and development. It also promotes alveolarization.

Initial experience with laparoscopic Chait Trapdoor cecostomy catheter placement for the management of fecal incontinence in children: outcomes and lessons learned.

Background: Antegrade enemas administered through a percutaneously placed Chait Trapdoor cecostomy catheter have resulted in a marked improvement in compliance and outcome of patients with fecal incontinence. The percutaneous technique, however, is a two-step procedure that is not performed under direct vision. This report presents the results and lessons learned from our experience with the laparoscopic approach to placement of Chait cecostomy catheters.

Early experience with the use of rhomboid excision and Limberg flap in 16 adolescents with pilonidal disease.

Background: Rhomboid excision with Limberg flap (RELF) repair has been shown to be effective in the management of pilonidal disease (PD) in adults. Wide excision allows complete removal of diseased tissue, and the rotational flap allows tensionless coverage as well as helps flatten the natal crease, which is believed to contribute to the recurrence of PD.

Methods: This study is a retrospective review of all adolescents who underwent excision of pilonidal disease using RELF at a single institution for a period of 18 months.

Lawn mower-related projectile injury.

Lawn mower injuries are a potentially devastating, yet preventable cause of morbidity and mortality in the pediatric population. The sequelae to these injuries can become even worse if the initial presentation goes unsuspected by medical staff, leading to a delay in treatment. The authors report the case of a lawn mower-related penetrating missile injury, where the extent of injury was not appreciated by the patient until signs and symptoms of a soft-tissue infection developed, prompting the patient to seek medical attention the next day.

Laparoscopic excision of a newborn rectal duplication cyst.

Congenital rectal duplication cyst is a rare entity treated with surgical excision. Without treatment, a rectal duplication cyst may cause a variety of complications, most notably, transforming into a malignancy. We report on a 7-week-old girl who was found to have a rectal duplication cyst.

Of snakes and babies: intrathoracic stomach and vertebral rachischisis. A serpentine-like syndrome?

Snakes have intrathoracic stomachs and rachischisis-like spinal vertebrae. These anomalies are rare in babies and have not been previously described in combination in the English medical literature. Here we present 2 cases of total intrathoracic stomach with a foreshortened esophagus, cervical spine rachischisis, and splenic anomalies in newborns.

Congenital bilateral absence of the vas deferens.

A 10-year-old boy with cystic fibrosis (CF) (DeltaF508/G551D mutation) underwent an uneventful elective interval laparoscopic appendectomy. During routine laparoscopic inspection of the abdomen and groins, congenital bilateral absence of the vas deferens was noted. Pictures of the patient's internal inguinal ring noted at time of laparoscopy are presented and compared with a similar-aged patient's internal ring with a normal vas deferens.

Gastrointestinal malrotation with volvulus in an adult.

Case presentation and literature review for intestinal malrotation presenting in an adult. Although the number of patients with this condition that escape infancy undiagnosed is not clear, it is clear that when the rare patient presents as an adult it can be a perplexing situation for surgeons not familiar with the presenting signs and anatomy. This confusion can lead to diagnostic and intraoperative errors.

Clinical and molecular characteristics of staphylococcal skin abscesses in children.

Forty-nine children with skin abscesses (36 methicillin-resistant Staphylococcus aureus and 13 methicillin-susceptible S. aureus) exhibited similar disease severity. Both pathogen groups were pulse field type USA300, multilocus sequence type 8, and possessed Panton-Valentine leukocidin genes.

Laparoscopic inversion and ligation inguinal hernia repair in girls.

Inguinal hernia repair is one on the most frequently performed operative procedures in pediatric surgery. The technique of high ligation of the hernia sac has been described for over a century and has proven to be a highly effective and durable repair. Several laparoscopic repairs have been described but, at least in boys, all of them have a slightly higher recurrence rate.

Antenatal vitamin A decreases ventilation-induced lung injury in the lamb model of congenital diaphragmatic hernia.

Objective: Infants with congenital diaphragmatic hernia (CDH) are susceptible to ventilation-induced lung injury. Vitamin A may protect the lung from injury during ventilation. The authors investigated the effects of antenatal vitamin A on ventilation-induced lung injury in CDH lambs using lung myeloperoxidase (MPO) activity as an indicator of lung injury.

Cardiopulmonary resuscitation in patients with a Nuss bar--a case report and review of the literature.

Pectus excavatum (PE) is a common chest wall deformity that may produce a variety of physiological and psychological effects in children and adolescents. In addition, some of these patients have associated cardiac diseases (ie, mitral valve prolapse and Marfan syndrome). Recently, a minimally invasive surgical repair of PE that requires sternal bar placement has become increasingly frequent to enhance patients' cardiopulmonary functioning as well as their self-esteem.

Reduced social morbidity of laparoscopic appendectomy in children.

Laparoscopic appendectomy has not been uniformly adopted by pediatric surgeons. Our children's hospital adopted laparoscopic appendectomy due to perceived benefits to patients and their families. We hypothesized that laparoscopic appendectomy in children resulted in less social morbidity than those undergoing open appendectomy.