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Fasciitis and abdominal abscess, followed by bowel obstruction could be the first manifestation of a silent perforated appendicitis. So, clinicians should evaluate the patient's complete clinical picture to prevent misdiagnoses and delays in care.

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Machine-learning-assisted Preoperative Prediction of Pediatric Appendicitis Severity.

J Pediatr Surg

January 2025

McGill University Faculty of Medicine and Health Sciences, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Qc, Canada.

Purpose: This study evaluates the effectiveness of machine learning (ML) algorithms for improving the preoperative diagnosis of acute appendicitis in children, focusing on the accurate prediction of the severity of disease.

Methods: An anonymized clinical and operative dataset was retrieved from the medical records of children undergoing emergency appendectomy between 2014 and 2021. We developed an ML pipeline that pre-processed the dataset and developed algorithms to predict 5 appendicitis grades (1 - non-perforated, 2 - localized perforation, 3 - abscess, 4 - generalized peritonitis, and 5 - generalized peritonitis with abscess).

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Ultrasound is a first-line and often preferred imaging modality in the diagnosis of acute appendicitis. When the appendix is not visualised during a dedicated appendix ultrasound study, patients may require a CT study, which uses ionising radiation, or undergo conservative clinical observation with the inherent risk of clinical deterioration, perforation and sepsis. Median baseline data, at our hospital imaging department, revealed a rate of combined normal and abnormal appendix visualisation of 34.

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Enteroenteric fistula in the pediatric age group is an unusual presentation. It can create a diagnostic dilemma for the physician, particularly in the absence of any previous surgery, prolonged abdominal symptoms, or inflammatory bowel disease. The patient is a 10-year-old girl who presented with mild-grade fever, abdominal distension, scanty stool passage, and foul-smelling vomiting for the past 10 days.

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Comparison of Postoperative Antibiotic Protocols for Pediatric Complicated Appendicitis: A Western Pediatric Surgery Research Consortium Study.

J Pediatr Surg

January 2025

Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA; Division of Pediatric Surgery, Dept of General Surgery, UCSD School of Medicine, La Jolla, CA, USA. Electronic address:

Background: There is no consensus on the appropriate duration of postoperative antibiotics for complicated appendicitis in children. Commonly used antibiotic endpoints include normalization of white blood cell count (WBC) or completion of a minimum number of prespecified treatment days. We compared clinical outcomes resulting from varying postoperative antibiotic protocols for complicated appendicitis in children.

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