During a five-year period from 1979 to 1985, 100 consecutive children with perforated appendicitis were managed at our institution. These patients were divided into two groups, which were determined, by length of illness and physical findings. Group A consisted of 88 children with signs and symptoms of peritonitis from appendiceal perforation. They were treated with fluid resuscitation, antipyretics, and triple antibiotics (ampicillin, gentamicin, clindamycin), and appendectomy within a few hours of hospitalization. Saline lavage was used. Group B was composed of 12 patients with a periappendiceal mass without generalized peritonitis who had symptoms of 6 to 12 days duration. They were treated nonoperatively with triple antibiotics and underwent interval appendectomy 4 to 6 weeks later. The complication rate for Group A was 6.8%. This included three wound infections (3.4%), one intra-abdominal abscess (1.1%), one patient with pneumonia and ileus (1.1%), and a small bowel obstruction (1.1%). These results are equivalent to the lowest complication rate reported in the literature, in which the treatment included transperitoneal drainage, antibiotic lavage, and parenteral antibiotics Group B patients had a 16.7% complication rate, which included one small bowell obstruction and one recurrent intra-abdominal abscess. Our method of management resulted in the lowest complication rate reported to date in children with perforated appendicitis. Transperitoneal drainage, delayed wound closure, and antibiotic lavage were not used. Subcuticular incisional closure resulted in minimal wound care and excellent cosmetic results. The experience demonstrates that with proper timing of surgery and appropriate use of contemporary antibiotics, the morbidity of perforated appendicitis can be limited and excesses of treatment can be avoided.

Duplication of the entire small intestine resulting in gastrointestinal hemorrhage was managed by excision of the ulcerogenic lesion, ileo-ileostomy, and diversion of the gastric-lined intestinal duplication into the stomach. A 25 yr followup study reveals no evidence of recurrent bleeding or malabsorption secondary to blind-loop syndrome. This operative procedure is worthy of consideration in patients with this congenital anomaly.

Teratomas of the cervical area are relatively rare tumors — only 132 cases have been reported. This paper adds two more cases to the literature and reviews the important clinical aspects of the disease. This tumor commonly presents in early infancy with increasing respiratory distress; polyhydramnios is commonly associated with tumors greater than 10 cm in diameter. They are always benign in infants and are believed to arise from the thyroid gland. Prompt surgical removal is mandatory. Thyroid function studies should be initiated preoperatively, if feasible, and definitely postoperatively to avoid the possible complication of hypothyroidism in the young infant.

Teratomas of the cervical area are relatively rare tumors--only 132 cases have been reported. This paper adds two more cases to the literature and reviews the important clinical aspects of the disease. This tumor commonly presents in early infancy with increasing respiratory distress; polyhydramnios is commonly associated with tumors greater than 10 cm in diameter. They are always benign in infants and are believed to arise from the thyroid gland. Prompt surgical removal is mandatory. Thyroid function studies should be initiated preoperatively, if feasible, and definitely postoperatively to avoid the possible complication of hypothyroidism in the young infant.