Clinical and Imaging Mimickers of Acute Appendicitis in the Pediatric Population

Abstract Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

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Changes in the prevalence of index diseases in pediatric surgery: case analysis of single national children’s hospital

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.3.232 ◽

2021 ◽

Vol 64 (3) ◽

pp. 232-238

Author(s):

Soo-Hong Kim ◽

Yong-Hoon Cho ◽

Hae Young Kim

Keyword(s):

Acute Appendicitis ◽

Pediatric Surgery ◽

Pediatric Population ◽

Hypertrophic Pyloric Stenosis ◽

Relative Number ◽

Emergency Operation ◽

Absolute Number ◽

Live Births ◽

Children's Hospital ◽

Children’S Hospital

Pusan National University Children’s Hospital (PNUCH) opened in November 2008 as the second National Children’s Hospital in Korea and celebrated its 10th anniversary in 2018. In the last decade, birth rates and pediatric populations have been declining sharply and has been more serious in Busan, Ulsan, and Gyeongsangnam-do where the PNUCH is located, affecting the prevalence of index diseases. The number of the index diseases was investigated by year according to changes in the population. Patients who underwent surgery at PNUCH for 10 years were included. Changes in pediatric population and the number of live births were analyzed using the data from Statistics Korea. The number of the index diseases was analyzed retrospectively through the review of electronic medical records. Statistical analysis was performed through Poisson regression. The number of live births and pediatric population decreased from 69,528 to 48,600 (30.1%) and 1,880,284 to 1,444,961 (23.2%), respectively. Operations of pediatric surgery decreased by 32.3% compared to that during the peak season, but the prevalence rate ratio of the pediatric population increased to 1.03 (<i>P</i><0.001). The number of emergency operation increased due to the largest surge in acute appendicitis operations. Both esophageal atresia and Hirschsprung disease decreased, while hypertrophic pyloric stenosis significantly increased. The absolute number of pediatric surgery cases decreased. However, considering the changes in pediatric population and the number of live births, the relative number of pediatric surgery cases does not changed. The decrease in the number of each disease would be related to the decrease in pediatric population and the number of live births. We should consider the increase of emergency operations such as acute appendicitis.

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Postoperative complicated appendectomy revealing Crohn’s disease in a pediatric patient

Journal of Mind and Medical Sciences ◽

10.22543/7674.81.p154160 ◽

2021 ◽

Vol 8 (1) ◽

pp. 154-160

Author(s):

Augustina Enculescu ◽

Mircea Lupusoru ◽

Catalin Cirstoveanu ◽

Andra-Iulia Suceveanu ◽

Liliana Andronache ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Acute Appendicitis ◽

Histopathological Examination ◽

Pediatric Population ◽

Pathological Examination ◽

Ileocecal Resection ◽

Initial Manifestation ◽

Adequate Treatment ◽

Granulomatous Appendicitis

Granulomatous appendicitis is a very rare entity in children. It is related to Crohn’s disease in only 5-10% of the cases. The diagnosis of Crohn’s disease is a real challenge in the pediatric population, especially when its initial manifestation is acute appendicitis. Herein, we present a 13-year-old boy admitted for acute appendicitis. The histopathological examination was conclusive for acute granulomatous appendicitis. The development of an entero-cutaneous fistula has complicated the postoperative evolution. The failure of the conservative management required ileocecal resection. The pathological examination revealed Crohn’s disease. The one-year follow-up on the patient din not reveal any complications. We strongly support the importance of the histopathological examination of the entirely removed appendix. Careful assessment of granulomatous appendicitis is needed in order to establish its possible etiology and to initiate the adequate treatment.

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Acute Appendicitis: Investigating an Optimal Outer Appendiceal Diameter Cut-Point in a Pediatric Population

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.08.027 ◽

2014 ◽

Vol 46 (2) ◽

pp. 157-164 ◽

Cited By ~ 13

Author(s):

Patrick M. Prendergast ◽

Naveen Poonai ◽

Tim Lynch ◽

Scott McKillop ◽

Rodrick Lim

Keyword(s):

Acute Appendicitis ◽

Pediatric Population ◽

Cut Point

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The diagnosis of acute appendicitis in a pediatric population: To CT or not to CT

Journal of Pediatric Surgery ◽

10.1053/jpsu.2003.50110 ◽

2003 ◽

Vol 38 (3) ◽

pp. 367-371 ◽

Cited By ~ 71

Author(s):

Antonia E. Stephen ◽

Dorry L. Segev ◽

Daniel P. Ryan ◽

Mark E. Mullins ◽

Samuel H. Kim ◽

...

Keyword(s):

Acute Appendicitis ◽

Pediatric Population

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Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Annals of African Surgery ◽

10.4314/aas.v18i1.7 ◽

2021 ◽

Vol 18 (1) ◽

pp. 34-38

Author(s):

Saeed Al Hindi ◽

Husain Al Aradi ◽

Mohamed Mubarak ◽

Noor AlHashimi

Keyword(s):

Acute Appendicitis ◽

Operative Time ◽

Pediatric Population ◽

Intraoperative Complications ◽

Open Appendectomy ◽

Safe Alternative ◽

Surgical Emergencies ◽

Uncomplicated Appendicitis ◽

Laparoscopic Assisted ◽

First Time

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent. Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy

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Frequency and outcome of complicated appendicitis in toddlers and pre-schoolers

Journal of Pediatric and Adolescent Surgery ◽

10.46831/jpas.v1i1.5 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Naseem Khan ◽

Muhammad Ayub Khan ◽

Jehangir Khan ◽

Sajjad Ali ◽

Imran Khattak ◽

...

Keyword(s):

Acute Appendicitis ◽

Pediatric Population ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Complicated Appendicitis ◽

Cross Sectional ◽

Generalized Peritonitis ◽

Operative Findings ◽

Study Participants ◽

Emergency Abdominal Surgery

Background: Acute appendicitis is a frequent indication of emergency abdominal surgery in the pediatric population. In younger children, especially toddlers, and preschoolers, the presentation is comparatively late resulting in complicated appendicitis. This study was done to determine the frequency and outcome of complicated appendicitis in toddlers and preschoolers. Methods: This is a cross-sectional study done at the Department of Pediatric Surgery, Lady Reading Hospital Peshawar, during August 2018 and February 2019. The medical records of 144 toddlers and preschoolers who presented with acute appendicitis were reviewed for demography, clinical presentation, operative findings, and outcome. Frequency and types of complicated appendicitis were recorded. Results: The mean age of study participants was 3 years (±2.84), including 46(32%) toddlers and 98(68%) preschoolers. Overall 62% of patients were male while 38% of patients were female. Complicated appendicitis was documented in 75% of patients. The common types of complicated appendicitis were perforation of the appendix with a localized abscess in 68 patients, gangrenous appendicitis in 4 patients, generalized peritonitis in 24 patients, and mass formation in 12 patients. All patients did well after surgery, except one who succumbed to complications of leukemia. Conclusion: In our study, a great deal (75%) of toddlers and preschoolers had complicated appendicitis especially perforated appendicitis with localized peritonitis.

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COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20213012 ◽

2021 ◽

Vol 48 ◽

Author(s):

LORAINE ENTRINGER FALQUETO ◽

CAROLINA MARTINS VISSOCI ◽

ISABELLA CRISTINA BONETTO FERREIRA ◽

AMANDA GINANI ANTUNES ◽

FERNANDO ANTÔNIO BERSANI AMADO ◽

...

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Initial Phase ◽

Pediatric Patients ◽

Pediatric Population ◽

Gastrointestinal Symptoms ◽

Signs And Symptoms ◽

Clinical History ◽

Pediatric Hospital ◽

Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

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