Background and Objectives: Acute appendicitis in pediatric patients is one of the most common surgical emergencies, but the early diagnosis still remains challenging. The aim of this study was to determine the predictive value of Red blood cell distribution width (RDW), Mean platelet volume (MPV) and Platelet distribution width (PDW) in children with acute appendicitis. Materials and Methods: This study was a retrospective assessment of laboratory findings (RDW, MPV, PDW) of patients who underwent surgical treatment for acute appendicitis from January 2019 to December 2020. Result: During this period, 223 appendectomies were performed at our Institute. In 107 (43%) cases appendicitis was uncomplicated, while in 116 (46.6%) it was complicated. WBC and RDW/MPV ratio were significant parameters for the diagnosis of acute appendicitis with cut-off values of 12.86 (susceptibility: 66.3%; specificity: 73.2%) and 1.64 (susceptibility: 59.8%; specificity: 71.9%), respectively. WBC and RDW/RBC ratio were independent variables for the diagnosis of complicated appendicitis. The cut-off values were 15.05 for WBC (sensitivity: 60.5%; specificity: 70.7%) and 2.5 for RDW/RBC ratio (sensitivity: 72%; specificity: 52.8%). Conclusions: WBC is an important predictor of appendicitis and complicated appendicitis. RDW, MPV and PDW alone have no diagnostic value in pediatric acute appendicitis or predicting the degree of appendix inflammation. However, the RDW/MPV ratio can be an important predictor of appendix inflammation, with higher values in patients with more severe appendix inflammation. RDW/RBC ratio may be an important predictor of complicated appendicitis.

Introduction/Objective. Surgery is a “gold standard” in treating the acute appendicitis in pediatric patients. The aim of the study was to determine the effect of open and laparoscopic appendectomy on postoperative recovery, return to everyday activities and quality of life in patients operated for the acute appendicitis. Methods. This prospective study was performed at the Institute for Children and Youth Healthcare of Vojvodina, during a period of ten months. This study was approved by Ethic committee of the Institute. All patients treated for the acute appendicitis by surgery were divided into two basic groups: open or laparoscopic appendectomy and into three subgroups, depending on the degree of appendicitis. We analyzed length of surgery, oral intake, establishing peristalsis, hospital stay, return to everyday activities and quality of life after surgery. Results. Laparoscopic technique was performed in 60 patients (48%), and the open method in 65 (52%). In laparoscopically treated patients (66.7%), peristalsis occurred earlier (p < 0.001), length of hospital stay was shorter (5.95 ± 1.21 days) (Z = -3.054; p = 0.002), the total score of daily activities showed a statistically significantly better score (Z = -7.667; p = 0.000), and they achieved a high level of quality of life significantly earlier (t = 2.773; p = 0.007). Conclusion. The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of every day functioning, faster recovery, and a good quality of life.

Introduction/Objective. Studies about possibilities of conservative, i.e., non-operative management of acute uncomplicated appendicitis in adult and pediatric population have been published lately, considering benefits of preserving appendix and potential complications related to appendectomy. Methods. In this retrospective study, medical data of 76 patients treated at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad for acute uncomplicated appendicitis in 2015 and 2016 have been analyzed, comparing length of stay, antibiotic therapy use, complications occurrence, as well as the financial burden depending of the type of therapy applied. Results. During this period, 76 patients (55 operated on and 21 treated conservatively) were treated for acute uncomplicated appendicitis. Conservatively treated children spent statistically significantly shorter period of time at the hospital compared to the ones operated on (4.24 vs. 5.76 days; p < 0.001). Early surgical complications occurred in 10.91% of those operated on and in 9.52% conservatively treated children, which was not a statistically significant difference (p = 0.863). The total cost of hospital stay was significantly lower in those who underwent non-operative management (10,340 RSD vs. 54,281 RSD; p < 0.001). The difference was significant even when analyzing costs related to rehospitalization and operative treatment of children initially treated conservatively (p < 0.001). Conclusion. Non-operative, i.e., conservative treatment of acute uncomplicated appendicitis in the pediatric population is safe and effective compared to the operative one, and it is not associated with more frequent occurrence of early surgical complications. Total costs for the non-operative treatment are significantly lower, even considering costs related to re-hospitalization of children initially treated conservatively.

Introduction. Duodenal atresia is one of the most common small bowel anomalies usually diagnosed in utero. We present a case of a newborn with duodenal atresia associated with intestinal volvulus and meconium peritonitis. Case Report. A premature newborn with a birth weight of 1970 g was admitted due to radiological signs of duodenal atresia. Intraoperatively, in addition to duodenal atresia, we found that almost all intestinal loops were adherent to each other and to the liver in the form of conglomerates, as a consequence of intestinal (jejunal) volvulus and meconium peritonitis. A minimal intestinal resection was performed with creation of duodeno-jejunal anastomosis. The postoperative course was prolonged due to serious complications including cardiac tamponade and sepsis. After 77 days, with full enteral feeding, spontaneous bowel movement, and after appropriate weight gain, the child was discharged from the clinic. Conclusion. Treating congenital anomalies of the newborn is a challenge, even for an experienced surgeon, especially when associated with premature birth and low birth-weight. Despite adequate surgical techniques and intensive treatment, complex congenital anomalies are associated with high morbidity and mortality rates.