Objectives: This study aims to evaluate the outcomes of patients who underwent penoscrotal webbing (PSW) repair using the Z-plasty and reverse (mirror-image) Z-plasty techniques. Patients and methods: Between 2016 and 2020, a total of 81 patients identified with PSW during circumcision evaluation who underwent simultaneous circumcision and web repair were enrolled and divided into two groups based on the surgical approach performed: the Z-plasty group (Group 1) (45 males; mean age: 31.9 ± 15.8 months; range, 12 to 72 months) and the reverse Z-plasty group (Group 2) (36 males; mean age: 31.8 ± 17.8 months; range, 12 to 72 months). All patients were followed for 12 months and evaluated for scrotal or penile edema, hematoma, recurrent webbing, wound contracture, infection, flap necrosis, and cosmetic outcomes. Results: The mean age, body weight, and operative time of Group 1 and Group 2 were 31.9 ± 15.8 months and 31.8 ± 17.8 months, 15.1 ± 3.9 kg and 14.8 ± 3.8 kg, and 49.4 ± 10.5 min and 49.1 ± 9.7 min, respectively. No statistically significant differences were observed between the groups regarding age, body weight, operative time, number of Z-plasties, or postoperative complications ( p > 0.05). Conclusion: It has been observed that Z-plasty and reverse Z-plasty techniques are effective in PSW repair and yield similar results.
Pediatric intestinal pseudo-obstruction (PIPO) is a rare clinical condition characterized by signs of bowel obstruction in the absence of any mechanical narrowing or occlusion of the intestinal lumen, resulting from gastrointestinal motility dysfunction. In approximately 80% of cases, symptoms emerge within the first year of life. The etiology of PIPO may involve genetic predisposition, as well as triggering factors such as infections, surgical procedures, anesthesia, stress, and malnutrition. In this case, PIPO was diagnosed in a patient with prolonged diagnostic delay due to persistent ileus episodes following perforated appendicitis, thanks to a multidisciplinary approach. The patient responded well to neostigmine therapy. In conclusion, this case highlights the late-onset form of PIPO and emphasizes the challenges in the diagnosis and treatment process.
Objectives: This study aims to develop a clinically applicable and interpretable decision tree-based model using routine clinical and laboratory parameters to differentiate acute appendicitis (AA) from nonspecific abdominal pain (NAP) in pediatric patients. Patients and methods: This retrospective study included 708 pediatric patients presenting with abdominal pain between January 2019 and December 2023. Demographic characteristics, physical examination findings, laboratory parameters, and Alvarado scores (AS) were analyzed. The dataset was divided into training and held-out internal validation sets using stratified sampling to preserve class distribution. Model performance was evaluated using stratified five-fold cross-validation on the training set, while the held-out internal validation set was kept completely unseen during model development. Class imbalance was addressed using the Synthetic Minority Over-sampling Technique applied exclusively within training folds. The dataset was partitioned using stratified sampling, and a decision tree model based on the classification and regression tree algorithm with an entropy splitting criterion was constructed. Model performance was evaluated on the heldout internal validation set using area under the curve (AUC), precision-recall (PR)-AUC, and F1-score. Results: A total of 708 patients categorized into two groups: NAP group (296 males, 307 females; mean age: 10.20 ± 3.81 years, range, 4 to 17 years) and AA group (68 males, 37 females; mean age: 11.21 ± 3.51 years, range, 5 to 17 years) presenting with abdominal pain were recruited. Patients with AA had significantly higher white blood cell counts, neutrophil percentages, neutrophil-tolymphocyte ratios, C-reactive protein levels, and AS than those in the NAP group (all p < 0.001). Right lower quadrant (RLQ) tenderness emerged as the most important discriminative variable, followed by the AS, left shift, age, and anorexia. The decision tree model achieved an F1-score of 0.884, an AUC of 0.946, and a PR-AUC of 0.8545. Importantly, AA was associated with a very low likelihood in patients without RLQ tenderness and with low AS, defining a clinically meaningful low-risk subgroup. Conclusion: Decision tree-based models may serve as valuable adjuncts to clinical judgment in evaluating suspected pediatric AA, particularly by identifying low-risk patients for whom further diagnostic testing or imaging is unlikely to alter clinical management.
Gastric pneumatosis is an uncommon radiologic finding in children and may suggest underlying gastrointestinal pathology. Herein, we reported a five-month-old male infant with Down syndrome who presented with a one-month history of recurrent nonbilious vomiting. Upright abdominal radiography showed a markedly dilated stomach and intramural gas along the gastric wall, raising suspicion for proximal intestinal obstruction. An upper gastrointestinal contrast study revealed a partial obstruction at the level of the duodenum. Surgical exploration identified an annular pancreas encircling the second portion of the duodenum. Due to the anatomical configuration, a duodenojejunostomy was performed. The patient tolerated postoperative enteral feeding and was discharged uneventfully. At the six-month follow-up, the patient remained asymptomatic with appropriate weight gain. This case demonstrates that gastric pneumatosis, although rare, may serve as an early indicator of upper gastrointestinal obstruction. Recognizing this finding on plain radiographs can expedite further diagnostic evaluation and enable timely surgical management. Clinicians should consider anatomical causes, including congenital duodenal anomalies, particularly in syndromic infants with persistent vomiting.
Objectives: This study aims to compare the demographic characteristics, ultrasonographic findings, and functional outcomes of pediatric patients who underwent open or laparoscopic pyeloplasty in our clinic, thereby evaluating the effectiveness of both surgical techniques. Patients and methods: Between June 2017 and September 2025 a total of 49 patients were enrolled and divided into two groups based on the surgical approach performed: Open surgery group (29 males, 4 females; mean age: 1.30 ± 3.25 years; range, 0 to 14 years) and laparoscopic surgery group; (9 males, 7 females; mean age: 5.81 ± 3.90 years; range, 1 to 12 years). Data from patients who underwent open or laparoscopic pyeloplasty for ureteropelvic junction obstruction were retrospectively reviewed. Patients were categorized into two groups according to the surgical approach. Age, sex, laterality, presence of urinary tract infection (UTI), pre- and postoperative hydronephrosis (HN) grade, anteroposterior pelvic diameter (APD), parenchymal thickness, and mercaptoacetyltriglycine (MAG3) scintigraphy findings were compared. Mann-Whitney U, chi-square, and Wilcoxon signed-rank tests were used for statistical analysis. Results: Patients in the laparoscopic group were significantly older than those in the open group ( p < 0.001). Sex distribution differed between groups, with a higher proportion of males in the open group ( p < 0.05). No significant differences were observed regarding laterality of obstruction or the incidence of UTI. In the open pyeloplasty group, significant improvements in MAG3 drainage and differential renal function were observed when comparing preoperative and postoperative values ( p < 0.05). In the laparoscopic group, statistical comparison was not feasible due to insufficient paired postoperative MAG3 data. Preoperative MAG3 renal function values were significantly lower in the laparoscopic group ( p < 0.001). Preoperative HN grades were significantly higher in the open group ( p < 0.05). Both groups demonstrated significant reductions in HN grades during postoperative follow-up. In early postoperative assessments, HN grades and APD were lower in the laparoscopic group. Postoperative APD was significantly smaller in the laparoscopic group ( p < 0.05). Conclusion: Both surgical approaches are effective in relieving obstruction and preserving renal function. Laparoscopic pyeloplasty offers advantages in terms of minimal invasiveness, early morphological improvement, and cosmetic outcomes, whereas open surgery remains a reliable option in patients with severe HN.
