RESUMEN
Coronavirus (COVID-19) was a pandemic disease that was affecting our medical and surgical daily practice badly. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotic treatment alone. Non-operative treatment for simple acute appendicitis (NOTA) avoids surgery, the risks of general anesthesia, and long hospital stays. It also decreases the risk of exposure to coronavirus. We aimed to study the cost-effectiveness and outcome of NOTA during the COVID-19 pandemic and compared it to single-incision pediatric endo-surgery appendectomy (SIPESA). A prospective cohort study for NOTA of patients from 6 to 12 years old in the COVID-19 pandemic period from April 1st, 2020, to April 30th, 2021, patients were divided into two groups: Group S was managed by SIPESA, and Group N was managed by NOTA. Family education and assurance with detailed explanation were done for early detection of any complications, and we continue monitoring the patients until their complete recovery. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. Six cases (17%) in group N were converted to surgical management in the first 6 months of the study. The mean cost dropped from $2736/day to $400/day. The mean psychological stress for the children improved from 4.4 in April to 2 in September. The mean follow-up was 3.5 months. NOTA is a feasible, cost-effective approach, and we recommend it, as we have learned this lesson during the COVID-19 pandemic days.
Asunto(s)
Apendicitis , COVID-19 , Humanos , Niño , Pandemias , Estudios Prospectivos , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Estudios Retrospectivos , Enfermedad AgudaRESUMEN
INTRODUCTION: Epilopic appendagitis (EA) is an uncommon condition of abdominal pain caused by the local inflammation of the fat-filled peritoneal outpouchings due to torsion or thrombosis of its vessels leads to ischemia and gangrenous necrosis of the aappendages, as it can cause peritoneal irritation, acute ischemia, and fat necrosis. CASE REPORT: We present a case of epilopic appendagitis mimicking appendicitis of a 10 years old male, presented to the emergency department with severe right quadrant pain pointedly at the right lumbar area. Associated with constipation and nausea for once. Computed tomography (CT) scan with contrast was performed showing an ovoid fat structure with thin enhancing rim and surrounding inflammatory stranding as well as prominent lymph nodes at hepatic flexure, free fluid and no evidence of appendicitis. The patient was discharged with pain control medications. DISCUSSION: Epiploic Appendages are mobile, pedunculated peritoneal out pouches. Considering its mobility and narrow pedicle appendages are disposed to torsion leading to appendagitis causing local inflammation, peritoneal irritation, acute ischemia, and fat necrosis. The patient's main complaint would be a subacute lower abdominal pain, left-sided in 60-80% of cases. CONCLUSION: Early recognition of this condition is crucial to avoid an operation when unnecessary leading to prolonged hospital stays. The management is conservative with analgesic.
RESUMEN
Introduction: Few centers worldwide have advanced single-incision pediatric endosurgery (SIPES) for pediatric age group. Up to our knowledge this is the first study assessing the safety of SIPES cholecystectomy in children with sickle cell disease (SCD) done by surgical residents. Aims: To determine the feasibility, safety, and expediency of SIPES cholecystectomy in children with SCD performed by surgical residents. Materials and Methods: Retrospective study of all SIPES cholecystectomies performed in our unit from April 1, 2011 to March 31, 2018. We compared the outcome of SIPES cholecystectomy done by fellows and residents. SIPES Covidien 5-12 mm port was inserted through umbilicus. Long 50 cm laparoscope, straight regular instruments, and transabdominal gallbladder traction suture were used in all patients. The cystic duct and artery were identified and divided. The gallbladder is then dissected off the liver and extracted from the abdomen through the port. Results: Forty-three SCD patients underwent SIPES cholecystectomy for 7 years. Mean HbS was 37.56%. Mean age was 10 years. Twenty-four cases (56%) and 19 (44%) were performed by 8 fellows and 10 residents, respectively. Nine other procedures were done simultaneously with cholecystectomy and were excluded from the mean operative time (MOT). The MOT for all cases was 85 minutes, 78 minutes for fellows and 94 minutes for residents (P value is <.001). One extra port was inserted in 2 patients at the beginning of the series. Conclusion: SIPES cholecystectomy in children with SCD is safe and feasible if done by residents under supervision. Stepwise training is essential in this challenging surgery. Involving residents with other SIPES procedures and hands-on minimally invasive surgery single port workshops help them in improving their skills.