This study aimed to evaluate and compare the clinical, laboratory, imaging, and histopathological findings of pediatric patients diagnosed with reactive lymphoid hyperplasia (RLH) among those who underwent surgery with a pre-diagnosis of acute appendicitis. A retrospective analysis was conducted on 3,469 pediatric patients who underwent appendectomy between January 2013 and January 2025. A total of 259 patients with histopathologically confirmed RLH were included in the study. Their clinical presentations, laboratory parameters, imaging findings, and surgical notes were analyzed. Where possible, comparisons were made with the remaining cohort. Among the RLH cases, 61% were male, with a mean age of 11.6 ± 4.2 years. Inflammatory markers such as WBC and CRP were elevated in only a subset of patients. Although ultrasonographic findings frequently mimicked acute appendicitis, histopathological evaluation revealed no signs of true inflammation. Laparoscopic appendectomy was performed in 77.2% of RLH patients, and all were discharged without complications. During follow-up, some patients developed systemic or autoinflammatory conditions such as FMF, IBD, or celiac disease. Comparative analysis showed that such conditions were significantly more common in the RLH group than in the non-RLH cohort. RLH is a benign condition that may clinically and radiologically mimic acute appendicitis. In stable pediatric patients with low inflammatory markers, conservative management should be considered to avoid unnecessary surgical interventions. Preoperative identification remains challenging, highlighting the importance of a multidisciplinary diagnostic approach. This study, with one of the largest cohorts to date, provides new insights into the natural history and diagnostic pitfalls of RLH. Clinical trial number: Not applicable.

Gastrointestinal duplications are rare congenital anomalies. Herein, we present a single institutional experience in pediatric gastrointestinal tract duplications. Patient records from 2014 to 2019 were retrospectively evaluated for demographic data, clinical presentation, diagnostic methods, surgical findings, and pathological reports. This study included 19 patients, of whom 10 were males and nine were females, with a median age of 30 (21 days-15.5 years) months. Three patients were antenatally and three were incidentally diagnosed. Abdominal pain, vomiting, constipation, and perianal accessory orifice were the most common presenting symptoms. Preoperative diagnostic workup included ultrasonography (n=13), cross-sectional imaging (n=8), and nuclear scintigraphy (n=1). A preoperative diagnosis was possible in 14 (74%) patients. The duplications originated from the foregut in seven (37%) patients, midgut in seven (37%), and hindgut in five (26%). Cystic duplications were observed in 14 (74%) patients and tubular in five (26%). The total surgical excision with (n=8) or without (n=10) associated organ resection was possible in 18 patients. Partial cyst excision with a complete mucosal removal was done in 1 patient. Heterotopic mucosa was present in six (32%) specimens. The respiratory origin with thyroid transcription factor-1 positivity was contained in two para-esophageal duplications. Among five patients with heterotopic gastric mucosa, 1 had presented with perforation and the others with hemorrhage. Duplications may involve any gastrointestinal segment. The clinical presentation is highly variable because of the wide variation in the involved segment and sizes and the possibility of bearing heterotopic mucosa. The surgery aims to totally excise the cyst or at least totally remove the inner mucosal lining.

OBJECTIVE: The aim was to evaluate the outcomes of conventional anorectal manometry (ARMM) testing and biofeedback therapy in adolescents with functional constipation. METHODS: A retrospective analysis of ARMM findings in patients aged 10-18 years with intractable constipation over a 4-year period was conducted. RESULTS: Of the 41 patients (mean age, 13.5 +/- 2.44 years) included, 20 (48.7%) were male. Rectoanal inhibitory reflex (RAIR) was positive in all patients. Group 1 had 31 patients with dyssynergic defecation (DD) and Group 2 had 10 patients without DD. Anal canal resting pressure, squeeze test pressure, rectal defecation pressure, and first and urge sensation volumes were similar between the groups. Maximum tolerated volume and the relaxation percentage of RAIR were higher in Group 1 than in Group 2 (p<0.05). Among 31 patients referred for biofeedback therapy, 8 (25.6%) completed the program with complete resolution of their symptoms. The mean follow-up period for these patients was 21 +/- 14.7 months. CONCLUSION: DD is relatively common in patients with psychosocial adjustment disorders, and it can be diagnosed via ARMM. Despite the low rate of adherence to the therapy in the presented series, biofeedback therapy was highly effective in resolving the symptoms including soiling.

An experience regarding full-thickness rectal biopsies (FTRB) indications and results is presented. The records of patients who underwent FTRB between January 2010 and January 2022 were retrospectively reviewed. 107 patients were included. There were 66 men (61.6%) and 41 women (38.3%). The median age at biopsy was 15 (1–196) months. FTRB was performed in 81 patients who were unable to pass meconium in the first 48 hours or had intractable constipation. A stoma was performed in 26 patients before the rectal biopsy. Contrast colon radiography was conducted in 61 patients and/or anorectal manometry in 32 patients. Of the biopsies, 74 were full-thickness while 33 were not. Biopsies were repeated in 12 patients. Of the 49 (45%) patients with aganglionic specimens, data about nerve hypertrophy was reported in 37. Among these, 33 had nerve hypertrophy and 4 did not. A definitive surgery was performed in 44 of the 49 patients diagnosed with Hirschsprung disease (HD). Complications were observed in 7 (6.5%) of the patients. HD was histopathologically diagnosed. Biopsies that are not full-thickness can be of value when using immunohistochemistry stains.