Pediatric emergency medicine trisk 950
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If the urachus persists after birth, it can form a urinary fistula that drains at the
umbilicus. This problem is ordinarily noted in the newborn period. Older infants
or children may present with drainage at the umbilicus caused by persistence of
part of the urachus, even though connection with the bladder may be obliterated.
These urachal remnants also require surgical excision. Persistent drainage from
the umbilicus or infections near the umbilicus require surgical consultation and
imaging to evaluate for omphalomesenteric ducts, urachal cysts, urachal fistulas.
Occasionally, the diagnosis is determined at surgery due to bowel obstruction
related to the fibrous connections.
Suggested Readings and Key References
Appendicitis
Bachur RG, Callahan MJ, Monuteaux MC, et al. Integration of ultrasound
findings and a clinical score in the diagnostic evaluation of pediatric
appendicitis. J Pediatr 2015;166(5):1134–1139.
Dibble EH, Swenson DW, Cartagena C, et al. Effectiveness of a Staged US and
unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis.
Radiology 2018;286(3):1022–1029.
Duke E, Kalb B, Arif-Tiwari H, et al. A systematic review and meta-analysis of
diagnostic performance of MRI for evaluation of acute appendicitis. AJR Am J
Roentgenol 2016;206(3):508–517.
Gorter RR, The SML, Gorter-Stam MAW, et al. Systematic review of
nonoperative versus operative treatment of uncomplicated appendicitis. J
Pediatr Surg 2017;52(8):1219–1227.
Howell JM, Eddy OL, Lukens TW, et al. American College of Emergency
Physicians. Clinical policy: critical issues in the evaluation and management of
emergency department patients with suspected appendicitis. Ann Emerg Med
2010;55(1):71–116.
Kessler U, Mosbahi S, Walker B, et al. Conservative treatment versus surgery for
uncomplicated appendicitis in children: a systematic review and meta-analysis.
Arch Dis Child 2017;102(12):1118–1124.
Kharbanda AB, Dudley NC, Bajaj L, et al.; Pediatric Emergency Medicine
Collaborative Research Committee of the American Academy of Pediatrics.
Validation and refinement of a prediction rule to identify children at low risk
for acute appendicitis. Arch Pediatr Adolesc Med 2012;166(8):738–744.
Kharbanda AB, Stevenson MD, Macias CG, et al.; Pediatric Emergency Medicine
Collaborative Research Committee of the American Academy of Pediatrics.
Interrater reliability of clinical findings in children with possible appendicitis.
Pediatrics 2012;129(4):695–700.
Kharbanda AB, Vazquez-Benitez G, Ballard DW, et al. Development and
validation of a novel pediatric Appendicitis Risk Calculator (pARC).
Pediatrics 2018;141(4):e20172699.
Lipsett SC, Bachur RG. Current approach to the diagnosis and emergency
department management of appendicitis in children. Pediatr Emerg Care
2017;33(3):198–203.
Mittal MK, Dayan PS, Macias CG, et al. Pediatric Emergency Medicine
Collaborative Research Committee of the American Academy of Pediatrics.
Performance of ultrasound in the diagnosis of appendicitis in children in a
multicenter cohort. Acad Emerg Med 2013;20(7):697–702.
Stevenson MD, Dayan PS, Dudley NC, et al. Time from emergency department
evaluation to operation and appendiceal perforation. Pediatrics
2017;139(6):e20160742.
Intussusception
Amuddhu SK, Chen Y, Nah SA. Inpatient admission versus emergency
department management of intussusception in children: a systemic review and
meta-analysis of outcomes. Eur J Pediatr Surg 2019;29(1):7–13.
Applegate KE. Intussusception in children: evidence-based diagnosis and
treatment. Pediatr Radiol 2009;39(2):S140–S143.
Edwards EA, Pigg N, Courtier J, et al. Intussusception: past, present and future.
Pediatr Radiol 2017;47(9):1101–1108.
Fallon SC, Lopez ME, Zhang W, et al. Risk factors for surgery in pediatric
intussusception in the era of pneumatic reduction. J Pediatr Surg
2013;48(5):1032–1036.
Gray MP, Li SH, Hoffmann RG, et al. Recurrence rates after intussusception
enema reduction: a meta-analysis. Pediatrics 2014;134(1):110–119. Retrieved
from />Guo WL, Hu ZC, Tan YL, et al. Risk factors for recurrent intussusception in
children: a retrospective cohort study. BMJ Open 2017;7(11):e018604.
Kaiser AD, Applegate KE, Ladd AP. Current success in the treatment of
intussusception in children. Surgery 2007;142(4):469–475; discussion 475–
477.
Riera A, Hsiao AL, Langhan ML, et al. Diagnosis of intussusception by physician
novice sonographers in the emergency department. Ann Emerg Med
2012;60(3):264–268.
Smith J, Fox SM. Pediatric abdominal pain. Emerg Med Clin North Am
2016;34(2):341–361.
Somme S, To T, Langer JC. Factors determining the need for operative reduction
in children with intussusception: a population-based study. J Pediatr Surg
2006;41(5):1014–1019.
Weihmiller SN, Monuteaux MC, Bachur RG. Ability of pediatric physicians to
judge the likelihood of intussusception. Pediatr Emerg Care 2012;28(2):136–
140.
Malrotation
Brandt ML. Pediatric hernias. Surg Clin North Am 2008;88(1):27–43, vii–viii.
Gauderer MW. Acute abdomen. When to operate immediately and when to
observe. Semin Pediatr Surg 1997;6(2):74–80.
Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Semin
Pediatr Surg 2003;12(4):241–253.
Powell OM, Othersen HB, Smith CD. Malrotation of the intestines in children:
the effect of age on presentation and therapy. J Pediatr Surg 1989;24(8):777–
780.
Smith J, Fox SM. Pediatric abdominal pain. Emerg Med Clin North Am
2016;34(2):341–361.
Spigland N, Brandt ML, Yazbeck S. Malrotation presenting beyond the neonatal
period. J Pediatr Surg 1990;25(11):1139–1142.
Hernias
Chen LE, Zamakhshary M, Foglia RP, et al. Impact of wait time on outcome for
inguinal hernia repair in infants. Pediatr Surg Int 2009;25(3):223–227.
Erez I, Rathause V, Vacian I, et al. Preoperative ultrasound and intraoperative
findings of inguinal hernias in children: a prospective study of 642 children. J
Pediatr Surg 2002;37(6):865–868.
Gill FT. Umbilical hernia, inguinal hernias, and hydroceles in children: diagnostic
clues for optimal patient management. J Pediatr Health Care 1998;12(5):231–
235.
Sheldon CA. The pediatric genitourinary examination. Inguinal, urethral, and
genital diseases. Pediatr Clin North Am 2001;48(6):1339–1380.
Smith J, Fox SM. Pediatric abdominal pain. Emerg Med Clin North Am
2016;34(2):341–361.
Miscellaneous
Dillon PW, Cilley RE. Newborn surgical emergencies. Gastrointestinal
anomalies, abdominal wall defects. Pediatr Clin North Am 1993;40(6):1289–
1314.
Louie JP. Essential diagnosis of abdominal emergencies in the first year of life.
Emerg Med Clin North Am 2007;25(4):1009–1040, vi.
McCollough M, Sharieff GQ. Abdominal surgical emergencies in infants and
young children. Emerg Med Clin North Am 2003;21(4):909–935.
Munden MM. Ultrasonography in pediatric abdominal emergencies. Ultrasound
Clin 2013;8(3):335–353.
Van Heurn LW, Pakarinen MP, Wester T. Contemporary management of
abdominal surgical emergencies in infants and children. Br J Surg
2014;101(1):e24–e33.
Vasavada P. Ultrasound evaluation of acute abdominal emergencies in infants and
children. Radiol Clin North Am 2004;42(2):445–456.
