The suitable duration of antibiotic use following appendectomy for advanced appendicitis in children is still debated. A systematic review was performed, including published experimental and observational data of antibiotic use in children who had undergone appendectomy for advanced appendicitis. Data were extracted and analyzed according to predefined criteria. Twenty-eight studies were selected that included 2,284 patients. There was no consistency among the protocols regarding length of antibiotic use, discharge criteria, or use of home antibiotics following discharge. Limiting duration of antibiotic use to 3 days did not appear to be associated with higher rates of intraabdominal abscess or wound infection. In the absence of higher-level evidence, shortening of antibiotic regimens following surgery for pediatric complicated appendicitis appears to be safe.

A variety of skin-covered dorsal masses associated with spinal dysraphism have been described in the literature, including: lipoma, 1,2 lipomyelomeningocele 3 and more anatomically complex lesions that have been variably classified as spinal hamartomas, 4,5 mature teratomas, 6-9 midline dorsal appendages, 10 dorsal accessory limbs [11][12][13] and poorly organized parasitic twins. 14 Here we present the case of an infant born with a lipomatous lumbar mass with an attached digit and an underlying split cord malformation. The differential diagnosis of this complex is briefly discussed in relation to the categories outlined above. A unifying hypothesis for this otherwise ABSTRACT: Background: A male infant was born with a digit attached to a skin-covered lumbar lipomatous mass and an underlying split cord malformation. Methods: Surgical removal of the mass was performed at four months-of-age. By this time the digit had grown a nail and imaging and histology showed ongoing development of articulated phalanges. Results: The lipomatous mass contained a long bone, a clavicle-and scapula-like structure and a variety of other mature germ layer derivatives. These features raised a number of diagnostic considerations, including: mature teratoma, hamartoma, rudimentary parasitic twin, lipomyelomeningocele and dorsal accessory limb. Conclusions: Based on review of the literature, the authors hypothesize that there is a pathogenetically related spectrum of skincovered dorsal mass lesions, often associated with spinal dysraphism. These consist of a major lipomatous component and a variety of mature germ layer derivatives that can vary widely in their degree of anatomical organization from case to case.RÉSUMÉ: Masse lombaire lipomateuse avec appendice digital et malformation de la moelle épinière. Contexte : À la naissance, on a constaté chez un bébé de sexe masculin la présence d'un doigt fixé à une masse lipomateuse recouverte de peau à la région lombaire et d'une malformation sous-jacente de la moelle épinière. Méthodes : On a procédé à une exérèse chirurgicale de la masse lorsque le bébé était âgé de quatre mois. Un ongle avait poussé sur le doigt et des phalanges articulées en développement étaient visibles à l'imagerie ainsi qu'à l'histologie. Résultats : La masse lipomateuse contenait un os long, des structures ressemblant à une clavicule et à une omoplate ainsi que d'autres structures matures, dérivées des feuillets embryonnaires. Plusieurs diagnostics ont été considérés : un tératome mature, un hamartome, un jumeau parasite rudimentaire, un lipomyéloméningocèle et un membre dorsal accessoire. Conclusions : Après révision de la littérature, les auteurs ont émis l'hypothèse qu'il existe une gamme de masses dorsales recouvertes de peau qui sont reliées au point de vue pathogénique et souvent associées à une myélodysraphie. Elles sont constituées d'une composante lipomateuse importante et de structures matures variées, dérivées des feuillets embryonnaires, dont l'organisation anatomique varie considérablement d'un cas à l'...

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