Page 12 - Demo

12Highlights of EAP 2023Holger TillMedical University of GrazAustriaTo start the talk, Dr. Holger Till enlists the disorders and conditions that fall under the age-specific spectrum divided into newborn/infants, toddler/children and school age children. The study on doppler US for volvulus described volvulus as a typical whirl pool sign but %u2018a torturous tale%u2019. Partial mid-gut volvulus (Figure 1) shows a torsion of 360 degrees with a small mesenteric base and congestion of mesenteric lymphatics. Situs (Figure 2) shows a small mesenteric base with venous dilatation and congestion. A prolonged volvulus leads to complete necrosis of small bowel, can be life-threatening and known as short bowel syndrome.Acute Abdominal Pain:How to Make the Best DecisionPresentervomiting and pain, particularly when the vomiting is bile-stained. Evidence says IM presents with different symptoms through childhood depending on age. Postoperative complications are common after Ladd's procedure, particularly among extremely preterminfants and patients with severely affected circulation caused by midgut volvulus.The speaker then continues to speak about anotherstudy that aimed to evaluate the feasibility of recruiting children with acute appendicitis to an RCT comparing nonoperative treatment with appendectomy. It reports that non-operative treatment appears safe in children. About 92% of patients treated with antibiotics had resolution of symptoms. About 62% of patients treated with antibiotics for acute appendicitis have not had an operation during the first year of FU. One more study demonstrated children allocated to non-operative treatment reported higher shortterm quality of life scores, shorter duration of requiring analgesia, more rapid return to normal activities and shorter parental absence from work. These preliminary data suggest the need for larger RCT. In children less than5 years old with appendicitis, age has a direct correlation to the stage of disease. The youngest children presentwith more advanced appendicitis but are less likely to develop postoperative abscesses. To summarize, Dr. Till states that acute uncomplicated appendicitis (AUA) in children represents a spectrum. A uniform definition seems mandatory. Substantial evidence exists about the effective treatment of AUAwith antibiotics. In adults, AB-treatment has been established in surgical guidelines. Standard protocols for children and adolescents still pending. Exclusion criteria and %u201cpitfalls%u201d must be observed. Complications occurin both surgical and non-surgical arms. It is time toshift the paradigm for treating AUA. It trends towards non-surgical treatment. Stable, long-term interdisciplinary cooperation is mandatory.Figure 1: Partial mid-gut volvulus.Partial mid-gut volvulusFigure 2: Situs with small mesenteric base.Situs%uf0d8Small mesentericbase%uf0d8Venousdilatationand congestion%uf0d8Surgery: Release of Ladd%u2018sbandsand broadeningof mesenteryFurther ahead, Dr. Till says that the diagnosis of malrotation and volvulus should always be kept in mind when assessing any infant or child with symptoms of