Background: To compare outcomes for complicated appendicitis treated with early versus interval appendectomy and to identify which patients would likely benefit from early appendectomy. Methods: A retrospective review of complicated appendicitis was performed from 2010 to 2015. Patients were divided into early (EA) versus interval appendectomy (IA) groups. We compared demographics, complications and outcomes. Pearson's Chi square analysis and Student's T test analysis were performed. Results: We identified 316 patients (EA group 53% vs. IA group 47%). Interval appendectomy group had longer symptom duration [IA 3.8 vs. EA 2.3 days (p Z 0.0001)], increased leukocytosis [IA 18.7 vs. EA 17.2 (p Z 0.008)], more initial abscesses [IA 35% vs. EA 13% (p Z 0.0001)], more complications [IA 30% vs. EA 19%, (p Z 0.013) and prolonged total length of stay [(LOS), p Z 0.009]. Subgroup analysis of all patients revealed 80% of patients presented with 3 cm abscess and duration of symptoms (DOS) 5 days. Interval appendectomy patients with DOS 5 days and or 3 cm abscess on admission had no differences in clinical presentation. However, these patients had prolonged total LOS (IA 7.7 vs. EA 6.3 days, p Z 0.01) and increased complications (IA 29% vs. EA 19%, p Z 0.04). Conclusion: The majority of patients with complicated appendicitis in children present with small abscess (3 cm) and short symptom duration (5 days). This subset of patients might

Highlights This is the first ever reported case of sterile granulomas in a patient with PTLD. PTLD is a disease that could potentially be diagnosed with minimally invasive biopsy rather than diagnostic splenectomy. This report is to create awareness regarding potential presence of sterile granulomas and discuss use of biopsy before splenectomy.

Arterial dissections are a common cause of stroke in young patients. Dissection occurs when the structure of the arterial wall is compromised, allowing blood to collect between layers as an intramural hematoma. Symptoms of cervical artery dissection may include pain, Horner syndrome, cranial and cervical neuropathies, and pulsatile tinnitus. Treatment varies depending on the severity of symptoms but generally includes anticoagulation with surgical therapy reserved for patients with progressive neurologic symptoms or symptom recurrence while on maximum medical therapy. Here, we present the case of a traumatic internal carotid artery dissection with significant narrowing of the artery in a healthy 26-year-old female after self-manipulation of the neck. She developed Horner syndrome secondary to her dissection. Our patient was initially treated with anticoagulation and transitioned to clopidogrel and atorvastatin for outpatient treatment. Six-month follow-up computed tomography angiography showed complete resolution of her dissection. She had overall significant improvement in her symptoms with only mild residual ptosis on the follow-up examination. While the presentation of a patient with neurologic sequelae from a cervical artery dissection causing stroke is a well-known phenomenon, the mechanical cause in this particular case is rare. There have been several case reports in the literature detailing cervical artery dissections following cervical manipulative therapy by trained professionals (i.e. chiropractors, physical therapists, osteopathic physicians) but none occurring from self-manipulation of the neck. This case report details successful treatment of a rare case of internal carotid dissection following self-manipulation with appropriate medical therapy.

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