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Background: Laparoscopic Appendectomy (LA) is no longer a new procedure in pediatric surgery. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by an open procedure. The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children. Methods: Research was conducted at the Department of Pediatric Surgery, Shifa International Hospital Islamabad. Duration of study was 3 years after due approval from the ethical and research review board. Medical records of 42 patients who were operated on for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020 was reviewed. All patients were enrolled from the emergency department. Clinical assessment of the patients was done in a routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Patients who had simple uncomplicated appendicitis, who had open appendectomy, and those who had laparotomy for other reasons were excluded from the study. All those patients who had complicated appendicitis like perforation, abscess, mass, or gangrene were included in the study. Variables observed in this study were age, gender, operative findings, operative time, hospital stay and postoperative complications. Results: The mean age of the patients was 9.95 ±3.22 years. Of 42 patients, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5 ±20.03 minutes. Mean hospital stay was 2.23 ±1.55 days. Out of 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess, and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient who had appendicular mass developed urinary retention with periorbital puffiness postoperatively. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient with an appendicular abscess had a large collection in the right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation. Conclusion: Laparoscopy for complicated appendicitis is safe in children with only fewer complications. Despite our limited experience of laparoscopic appendectomy, we believe that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated. [ABSTRACT FROM AUTHOR]

Background: Foreign bodies in aero digestive tract is a common emergency in pediatric age group. Methods: This cross-sectional study included 156 patients of foreign bodies in aero digestive tract over a period of 2 years from January 2016 to December 2017. Results: Out of 156 patients, foreign body in esophagus was found in 111 patients with age range from 6 months to 12 years. Fifty-six patients (50%) belonged to 3-5 years age group. Coin was found in most of the patients which constitutes 61(55%) patients. Majority of the foreign bodies got impacted in cricopharynx. Of all the patients, 45 had foreign body in airway with age ranging from 6 months to 12 years. Peanuts were found in majority of cases, constituting 20% and right bronchus was mostly affected. One patient of foreign body ingestion expired. [ABSTRACT FROM AUTHOR]

Background: Congenital epulis is a rare benign, smooth, sessile, or pedunculated, solitary mass of varying sizes commonly occurring at the anterior alveolar ridge of the maxilla. It can occur as a solitary as well as a multifocal lesion. Case Presentation: Case 1: A two-day-old female newborn presented with a single round, smooth, pedunculated mass measuring 3x2x2cm on the anterior alveolar ridge of the maxilla. Complete excision of the mass was done under general anesthesia. Histopathology confirms congenital epulis. No recurrence was found till one year of follow-up. Case 2: A one-day-old female newborn presented with a 3x4x3cm soft to firm mass arising from the right upper alveolar margin attached with a stalk and extending into the mouth without any respiratory difficulty. Complete excision of the mass was done under general anesthesia. Follow-up for one year showed no recurrence. Conclusion: Congenital epulis is a rare benign lesion most commonly arising from the anterior alveolar ridge of the maxilla without the involvement of bone or teeth. Complete surgical excision is the treatment of choice without any reported recurrence. [ABSTRACT FROM AUTHOR]