scholarly journals 896 Can We Count on Serum Hyperbilirubinemia to Predict Acute Complicated Appendicitis?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Jaskani ◽  
Z Al-Hamid ◽  
D Chattopadhyay
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
High Specificity ◽  
District General Hospital ◽  
Liver Function Tests ◽  
Complicated Appendicitis ◽  
P Value ◽  
Generalized Peritonitis ◽  
Purulent Peritonitis

Abstract Aim Acute appendicitis (AA) is usually a clinical diagnosis and surgical intervention is typically a preferred choice to avoid potentially lethal complications like perforation and purulent peritonitis. Intra-abdominal inflammation can lead to hepatic cholestasis due to cytokine release, which can reflect as rise in bilirubin alone or in combination with other liver enzymes. The aim of this study was to evaluate hyperbilirubinemia as a predictor of complicated acute appendicitis (CA). Method A retrospective analysis of all the patients who underwent surgery for AA in a district general hospital in the UK from Jan 2018 to April 2019. All the patients underwent admission blood tests including White cell count (WCC), C- reactive proteins (CRP), and liver function tests (LFTs). For data collection hospital medical record was used. Complicated appendicitis (CA) was defined as Gangrenous, or perforated appendix wall, abscess formation, or generalized peritonitis. Results In total 236 patients underwent appendectomy. On histology 25 patients (10.6%) had normal appendix (NA). Furthermore, 161 patients (68.2%) had uncomplicated appendicitis (UA) and 50 patients (21.2%) had complicated appendicitis (CA). Serum Bilirubin (SB) was found to be statistically significantly raised in patients with CA (p value=0.0001) when compared with NA group. Overall sensitivity of SB, CRP and WCC for AA was(15.17%, 79.90%, and 57.82% respectively) and specificity was(100%, 36.36% and 68% respectively). Conclusions SB had low sensitivity and high specificity as compared to CRP and WCC for AA. Raised serum bilirubin levels can be considered as one of the supportive markers of complicated appendicitis.

scholarly journals Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

2017 ◽  
Vol 4 (4) ◽  
pp. 1341 ◽  
Author(s):  
Sadhan Kumar Cheekuri ◽  
Alok Mohanty ◽  
T. Ganesh ◽  
R. Kannan ◽  
Robinson Smile
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
P Value ◽  
Predictive Capacity ◽  
Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

scholarly journals Diagnostic value of serum bilirubin in appendicular perforation

2017 ◽  
Vol 4 (10) ◽  
pp. 3445
Author(s):  
Mallikarjuna M. N. ◽  
Utpala Uday
Keyword(s):  
Acute Appendicitis ◽  
Analytical Study ◽  
Serum Bilirubin ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Liver Function Tests ◽  
Diagnostic Value ◽  
Total Serum ◽  
P Value ◽  
The Mean

Background: Hyperbilirubinemia has been well documented in relation to acute appendicitis. This study tries to establish the diagnostic value of this parameter in determining the severity of acute appendicitis.Methods: This is a prospective analytical study conducted on 100 patients with acute appendicitis. All patients were subjected to clinical evaluation and investigations; including liver function tests. The diagnosis was confirmed peri-operatively and postoperatively by histopathological examination. The data was compiled and analysed.Results: The incidence of complicated appendicitis was found to be 18%, defined as evidence of gangrene, or microscopic or gross perforation on histopathological examination. Among these total serum bilirubin (TSB) was raised in 17 cases (17%) and statistically significant correlation was established by p-value <0.001. The mean of TSB level was higher in perforated appendicitis than in cases of acute appendicitis (0.57±0.26 mg/dL; range 0.1-1.2 versus 1.68±1.09 mg/dL; range 0.8-4.8 mg/dL). TSB was shown to have specificity of 96.4%, sensitivity 88.2%, PPV 83.3% and NPV was 97.6%. The diagnostic accuracy of raised bilirubin for diagnosis of appendicular perforation was calculated to be 95.0%. The rise in bilirubin was mixed in type (both indirect and direct). There could not be established any correlation between the liver enzymes and appendicitis or its complications.Conclusions: This study ascertains the predictive value of serum bilirubin in acute appendicitis patients as an indicator of severity. Raised bilirubin in the setting of acute appendicitis identifies higher probability of appendicular perforation. 

scholarly journals Comparison of Sensitivity of TLC and Liver Assay in Diagnosing Appendicitis and Complicated Appendicitis at a Rural Medical Institution

2020 ◽  
Vol 7 (46) ◽  
pp. 2710-2713
Author(s):  
Sandeep Kumar Goyal ◽  
Vilkram Saini ◽  
Minaxi Saini ◽  
Gopal Singhal ◽  
Kanishak Mehta ◽  
...  
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Liver Function Tests ◽  
Complicated Appendicitis ◽  
Total Serum Bilirubin ◽  
Total Leukocyte Count ◽  
Total Serum ◽  
Function Tests

BACKGROUND Diagnosis of acute appendicitis is always a challenging task in emergency ward which can most of the time be diagnosed with thorough history and physical examination by surgeon, various clinical signs and laboratory investigations like total leukocyte count (TLC), neutrophils shift to left. Unnecessary surgical interventions of appendix can be reduced by precise diagnosis of levels of TLC and total serum bilirubin values. We wanted to evaluate the sensitivity of laboratory marker like TLC and liver function tests in diagnosing a case of appendicitis and complicated appendicitis. METHODS 100 patients who were admitted in the Department of General Surgery, Maharaja Agrasen Medical Collage, Agroha (Hisar), with clinical diagnosis of acute appendicitis were included in the study. Data was statistically analysed and sensitivity of TLC and liver function test in diagnosing acute appendicitis was compared. RESULTS Sensitivity of TLC was found to be 47 %; that of total serum bilirubin was 72 % which is significant; that of SGOT was 26 %; that of SGPT was 21 % and that of ALP was 8 % in diagnosing acute appendicitis. While comparing sensitivity of this marker to diagnose complicated appendicitis (gangrenous and perforated appendix) it was 56.3 % for TLC, 100 % for total serum bilirubin, 31.3 % for SGOT, 37.5 % for SGPT and 12.5 % for ALP. CONCLUSIONS Raised total serum bilirubin has potential to detect complications of appendicitis and the need for early intervention by surgeon. KEYWORDS Appendicitis; Liver Function Tests; Serum Bilirubin

scholarly journals Role of liver function tests to assess severity of acute appendicitis and predict complications

2021 ◽  
Vol 8 (3) ◽  
pp. 885
Author(s):  
Puli Vineela ◽  
Nikhil Deshmukh ◽  
Krishnamurthy Penugondla
Keyword(s):  
Acute Appendicitis ◽  
Total Bilirubin ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Complicated Appendicitis ◽  
Direct Bilirubin ◽  
P Value ◽  
Institutional Ethics ◽  
Surgical Emergencies

Background: Acute appendicitis is commonest surgical emergencies of abdomen. Literature shows LFT can be used as a marker of acute appendicitis and may predict severity of appendicitis.Methods: An observational prospective study of 100 cases of acute appendicitis. Study period was from October 2018 to September 2020. Ethical clearance certificate was taken from Institutional ethics Committee. All patients underwent abdominal ultrasound, blood tests including LFT and appendectomy. Histopathology reports were analysed. Patients were divided into 2 groups- inflammatory and complicated appendicitis. Data was collected and statistically analysed using SPSS software version 19.Results: Out of 100 patients 64% are males and 36% females. 4% are negative appendectomies. Total bilirubin elevated in 60% of inflammatory and 89% of complicated appendicitis, p value=0.0053 (significant), sensitivity- 62%. Direct bilirubin elevated in 88% of inflammatory and 96% of complicated appendicitis, p value=0.05 (significant), sensitivity-69%. ALT, AST not raised in both groups. ALP elevated in 81% of inflammatory and 82% of complicated appendicitis with sensitivity-70.5%.Conclusions: LFT can be used to diagnose, assess severity and predict complications of acute appendicitis with elevations of total bilirubin, direct bilirubin and ALP being most useful. 

scholarly journals Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

2021 ◽  
Author(s):  
Andrew Phillip Maurice ◽  
Benjamin David Swinson ◽  
Eduardo Miguel Apellaniz ◽  
Sarah Emily King ◽  
Thomas Grant Mackay ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neutrophil Count ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
Delayed Diagnosis ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Operative Findings

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

scholarly journals Elevated serum bilirubin in acute appendicular perforation as a newer serum marker: a diagnostic validation test

2020 ◽  
Vol 7 (2) ◽  
pp. 414
Author(s):  
Bhimanagouda V. Goudar ◽  
Varsha R. Kanchan
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Marker ◽  
Serum Total Bilirubin ◽  
Histopathological Diagnosis ◽  
Delay In Diagnosis ◽  
Major Procedure ◽  
A Prospective Study

Background: Acute appendicitis is the commonest cause of acute surgical abdomen. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Delay in diagnosis and treatment results in increased rate of perforation, morbidity, mortality and hospital stay.Methods: A prospective study where a total of 100 patients with clinical, radiological and histopathological diagnosis of acute appendicitis or appendicular perforation were studied. The liver function tests were carried out in all the patients.Results: In a study group of 100 patients (74 males and 26 females); 59 cases were acute appendicitis and 41 cases were appendiceal perforation proven histopathological. Out of which 48 cases had elevated serum bilirubin levels i.e., 17 in acute appendicitis group and 31 in appendicular perforation group. The mean serum total bilirubin is 1±0.4 in acute appendicitis cases and 1.9±1.13 in the appendicular perforation cases. Similarly, the sensitivity and specificity of elevated serum bilirubin as a diagnostic marker in appendicular perforation was found to be 75.6% and 71.2% respectively.Conclusions: Elevated serum bilirubin levels appears to be a promising new supplemental diagnostic serum marker in Appendicular Perforation and perhaps be a decision-making investigation. 

scholarly journals Evaluation of Serum Bilirubin as a Predictive Marker for Simple and Complicated Appendicitis in Sulaimani Emergency Teaching Hospital

2018 ◽  
pp. 15-20
Author(s):  
Seerwan Hama Shareef ◽  
Seerwan Hama Shareef ◽  
Dara Ahmed Mohammed ◽  
Goran Ameer Ahmed
Keyword(s):  
Acute Appendicitis ◽  
Prospective Study ◽  
Teaching Hospital ◽  
Serum Bilirubin ◽  
Complicated Appendicitis ◽  
White Blood Count ◽  
Total Serum ◽  
Lower Sensitivity ◽  
Specific Marker ◽  
Suspected Appendicitis

Diagnosis of acute appendicitis can be challenging in some cases as the differentials can be exhaustive. Previous studies have demonstrated that hyperbilirubinemia is a more specific marker for appendicitis than white blood count (WBC) and C-reactive protein (CRP), but this investigation is still not commonly used in the diagnostic workup of appendicitis. This prospective study aims to evaluate serum bilirubin as a laboratory marker for simple and complicated appendicitis. We also investigated the diagnostic value of bilirubin in acute appendicitis and compared it with the WBC. In this prospective study, all patients who underwent appendicectomy at the Sulaimani Emergency Teaching Hospital between 1st November 2016 to 1st January 2017 were included. Preoperative total serum bilirubin was measured and compared with the final histopathology report. Patients were divided into 3 groups: non-inflamed appendix, simple appendicitis and complicated appendicitis. One hundred and 75 patients were analysed, 90 of them were females and 85 were males. Hyperbilirubinemia was found in 63% of patients with complicated appendicitis (p=0.001). Mean of bilirubin was significantly different between patients with complicated appendicitis and non-complicated appendicitis (1.101 vs 0.75 mg/dl; p= 0.0017). Bilirubin had a higher specificity (85%) than WBC (36%), but a lower sensitivity (63% vs 89%) for differentiating complicated appendicitis. Patients with suggestive features of acute appendicitis and raised serum bilirubin indicate a complicated case requiring early intervention to prevent peritonitis and septicaemia. Hyperbilirubinemia is a good indicator for complicated appendicitis and serum bilirubin measurement can be included in the work up of patients with suspected appendicitis.                       

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2021 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019.This was a prospective trial. Trial URL:http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

scholarly journals Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27.

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

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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