Pediatric emergency medicine trisk 3797 3797

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.