Purpose Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann–Whitney tests and logistic regression. Results This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis ( p <0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.

Introduction: Colorectal cancer or known as CRC, is rare among adolescents younger than 20 years old. CRC diagnosis in children is commonly delayed until it reaches the advanced stage due to the nonspecific symptoms mimicking other gastrointestinal disorders. Most CRC in children is poorly differentiated mucinous adenocarcinoma, in contrast to CRC in adults, mostly moderately or well-differentiated adenocarcinoma. The delay in diagnosing CRC in children leads to an extremely poor prognosis rather than adults. Thus, this article aimed to report a rare case related to the CRC in pediatric.Case presentation: A rare case of a 14-year-old male present with abdominal distention since a month before presented to the emergency department. He also complained of bilious vomiting and not passing stool for three days, there was decreased body mass of about 15 kilograms since a year ago, and a family history of malignancy was refused. There was a distended abdomen, arm contour and metallic sound. The full blood count showed no significant results. We found a dilated prominent bowel filled with air in the entire abdomen from plain abdominal radiography that led us to suspect total bowel obstruction. We decided to do an emergency exploratory laparotomy. Intraoperatively, we found multiple masses look like polyposis in the intraluminal of a descending colon ranging about 10 centimeters long. The histopathological finding showed adenocarcinoma well-differentiated colon T3N0. Postoperatively, there were no complications from the surgery until a month after surgery, and we suggested our patient continue his treatment with adjuvant chemotherapy.Conclusion: The treatment of colorectal cancer in pediatric is complete surgical resection of the tumor and chemotherapy. Early detection of colorectal cancer is required to prevent further morbidity and mortality.

<p><strong>Introduction</strong><strong>:</strong> Pancreatic injury is a rare case, caused by blunt or sharp trauma. Difficulty in making diagnose on pancreatic trauma cases are associated with high mortality, and the treatment can be either operative or conservatively. However, It is still unclear which treatment is more favorable.</p><p><strong>Case:</strong> We present 2 cases of Grade III pancreatic injury with stable hemodynamic who suffered bicycle accident. First case, 12-year-old boy complaining severe pain on the upper left abdomen (VAS 9-10) and get worsening by time, with vomiting. The patient underwent distal Pancreatectomy-Splenectomy. Second case, 8-year-old boy complaining of pain on the upper left abdomen (VAS 6-7) without extension on whole abdominal region with vomiting and fever. The patient was treated conservatively. In both cases, patient was discharged with improvement. However, about 3 months later patients who were treated conservatively developed into a pseudocyst.</p><p><strong>Conclusion:</strong> The selection of management in grade III pancreatic injury can be operative or conservative depending on clinical findings such as hemodynamic condition and the quality of abdominal pain. But the occurrence of pseudocysts pancreas is another surgical challenge.</p>