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

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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A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20204068 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1541

Author(s):

Rajesh Kumar ◽

Renu Chauhan

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Leucocyte Count ◽

Histopathological Examination ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Total Leucocyte Count ◽

Cross Sectional ◽

Gandhi Medical College ◽

Low Sensitivity

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

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Prevalence of perforated appendicitis and its determinants in pediatric appendicitis patients admitted in tertiary care centre, South India: a cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20185020 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3926

Author(s):

Chandrashekar S. ◽

Lokesh M. G. ◽

Avinash S. R.

Keyword(s):

Acute Appendicitis ◽

Tertiary Care ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Sectional Study ◽

Tertiary Care Centre ◽

Alvarado Score ◽

Cross Sectional ◽

Pediatric Age Group ◽

Perforated Appendix

Background: Appendicitis remains a common indication for urgent surgical intervention in pediatric age group. Acute appendicitis has the highest incidence during the second decade of life. When the diagnosis is performed, perforation could be already present in 30%-75% of children, with young children being at higher risk. The challenge for the practitioner is to perform a timely diagnosis of acute appendicitis in first years of life before complications occur.Methods: A facility based cross sectional study was conducted with sample size of 108. The patients diagnosed and operated for acute appendicitis using Alvarado score were correlated with intra operative findings.Results: Total 108 patients with median age of 11 (IQR 9–13) years, were included in the study in which 66% were male. Overall 18% (95% CI 11%-25%) had perforated appendix and 5% (95% CI 2%-11%) had appendicitis with abscess. Male gender, patients presenting with fever, guarding, rigidity and patients presenting 48 hours after developing symptoms, had higher chance of perforation. Mean count of WBC (17000 v/s 11000) and neutrophils (75% v/s 68%) were found to be higher in patients with perforated appendicitis.Conclusions: One-fifth of the pediatric appendicitis patients presenting in tertiary care patients had perforated appendicitis.

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NEGATIVE APPENDECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.02.1370 ◽

2015 ◽

Vol 22 (02) ◽

pp. 167-174

Author(s):

Mohammad Ibrar ◽

Bakhtiar Alam ◽

Zafar Malik

Keyword(s):

Acute Appendicitis ◽

Diagnostic Techniques ◽

Cross Sectional Study ◽

Reproductive Age ◽

High Rate ◽

Negative Appendectomy ◽

Cross Sectional ◽

Number Of Patients ◽

Operative Findings ◽

Gross Examination

Acute appendicitis is the most common surgical emergency. Despite advancesin diagnostic techniques, an accurate pre-operative diagnosis may still pose a challenge tothe clinicians. Therefore, even today we are facing a high rate of negative appendectomy.The current study explores this aspect of a common and important disease. Objectives: Toknow the percentage of negative operative findings in acute appendicitis in our hospital thatdrains wide area of population from lower socioeconomic strata. Patients and methods: Thisprospective cross-sectional study was conducted at Department of Surgery, Lady ReadingHospital, Peshawar within two years from 1-1-2009 to 31-12-2010. This study included 673cases undergoing appendectomy. All the patients operated for clinical diagnosis of acuteappendicitis over the study period were included. Their history, clinical features, and resultsof investigations were noted. Gross examination of intact appendix specimen, and on-tablecross sectional inspection of appendix was made; and were correlated with histopathologicalfindings (as gold standard). Results: The study included 673 patients. There were 478 males(70%), and highest number of patients was in second decade of life. On gross examination,545 (81%) appendices were swollen, 531 (79%) were reddened due to inflammation; 63 (9.4%)were gangrenous; and 50 (7.5%) had perforated; while in 128 patients (19%) the appendix wasnormal looking with shiny surface. Fibrino-purulent exudate in the peri-appendeceal regionwas noticed in 253 (37.6%) patients. The cut section of appendix showed wall abscess in 474(70.4%) cases, and mucosal ulceration in 325 (48.2%). Necrotic foci in mucosa were seen in188 (27.6%) cases, and in 61 cases (9%) the necrosis was extending through the wall up toserosa. Histopathology revealed marked acute inflammation in 416 (61.8%) cases, moderateinflammation in 92 (13.7%), and mild inflammation in 47 (6.9%); while in 118 cases the appendixhad no evidence of inflammation (giving negative appendectomy rate of 17.5%). Negativeappendectomy rate in females was 29.2% compared to 12.7% in males. Probable alternatediagnoses are also addressed. Conclusions: The negative appendectomy can be avoidedin many cases if ultrasound facilities were available during odd hours of patient presentation.Similarly, the rate of negative appendectomy can be further reduced in adults, especially femalesaround puberty and reproductive age, by the provision of laparoscopy during emergency hoursof the day.

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The Diagnostic Role of Hyperbilirubinemia in Complicated and Non -complicated Appendicitis.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i2.14 ◽

2018 ◽

Vol 2 (2) ◽

Author(s):

Valon Zejnullahu ◽

Rozalinda Isjanovska ◽

Besnik Bicaj ◽

Vjosa A. Zejnullahu ◽

Astrit R. Hamza ◽

...

Keyword(s):

Acute Appendicitis ◽

Clinical Signs ◽

Cross Sectional Study ◽

Complicated Appendicitis ◽

Clinical Approach ◽

Cross Sectional ◽

Laboratory Marker ◽

Diagnostic Role ◽

Sensitivity Specificity

Background: Acute appendicitis is one of the most frequent causes of abdominal pain. Early diagnosis is the key to success for the surgeon, followed by the treatment with operation or conservative treatment as a new approach, before the stage of gangrenous appendicitis or perforation occurs.Aim: This study aims to establish he role of hyperbilirubinemia as a laboratory marker in prediction of acute appendicitis in the early diagnosis.Materials and methods: This is a cross-sectional study; it included 201 patients admitted in the emergency ward with suspicion for acute appendicitis. All patients that participated in this study have been subject to appendectomy. The blood samples were taken from all patients in order to analyze the level of total/direct bilirubin.Results: The study samples of 201 patients consisted of 67.7% with complicated appendicitis and 32.3% with non-complicated appendicitis. The sensitivity, specificity, PPV, NPV for laboratory marker, as predictor for complicated vs non-complicated cases of appendicitis was as follows: Total bilirubin; specificity (72.3%), sensitivity (54.4%), PPV (80.4%), NPV (43.1%),Conclusion: Elevation of total/direct bilirubin level in patients with clinical signs of acute appendicitis might predict the stage of acute appendicitis, such prediction may help surgeons to provide accurate treatment of the disease without delay in the diagnosis. This accuracy can be further supplemented by using Alvarado scoring model during the clinical approach.

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Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience

Archives of Pediatric Infectious Diseases ◽

10.5812/pedinfect.107774 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Sedigheh Rafiei Tabatabaei ◽

Abdollah Karimi ◽

Mohammad Nassiri ◽

Leily Mohajerzadeh ◽

Shahnaz Armin ◽

...

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Pediatric Population ◽

Scoring Systems ◽

Cross Sectional Study ◽

Alvarado Score ◽

Cross Sectional ◽

Lower Quadrant ◽

Suspected Appendicitis ◽

Rebound Tenderness

Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P < 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.

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Accuracy Score on Raja Isteri Pengiran Anak Saleha (RIPASA) and Pediatric Appendicitis (PAS) for Diagnosing Acute Appendicitis in Children

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v2i2.32 ◽

2020 ◽

Vol 3 (2) ◽

pp. 102-111

Author(s):

Shalita Dastamuar ◽

M. Roby ◽

Sindu Saksono ◽

Erial Bahar

Keyword(s):

Acute Appendicitis ◽

Pediatric Patients ◽

Histopathological Examination ◽

Pediatric Population ◽

Cross Sectional Study ◽

Accuracy Score ◽

Cross Sectional ◽

Clinical Scoring ◽

Surgical Field ◽

Sensitivity Specificity

Abstract Introduction. Acute appendicitis is the most common case of acute abdomen. Diagnosis of acute appendicitis is still difficult and is one of the problems in the surgical field. The Clinical Scoring System (CSS) has been developed to help doctors classify risk categories. PAS has been widely evaluated in the pediatric population. In another study it was found that RIPASA had better sensitivity, specificity, and accuracy than PAS in pediatric patients. Methods. This study is a cross sectional study to assess the level of concordance between RIPASA and PAS scores in diagnosing acute appendicitis, with the gold standard of Histopathological examination. Samples were taken by consecutive method, in 30 patients aged <18 years for 1 year. Results. This study had an average age of 10.10 ± 3.745 years. Histopathologically early acute appendicitis 3.3%, acute suppurative appendicitis as much as 20%, acute gangrenous appendicitis 73.3% and others 3.3%. Using a cut-off point value of 9.5 for RIPASA and 7 for PAS, the sensitivity, Specificity, Accuracy of 82.75%, 100%, 80% for RIPASA, and 75.8%, 100%, 73.3% for PAS. Conclusion. The RIPASA score on the cut-off treshold 9.5 has better sensitivity and accuracy than PAS in diagnosing acute appendicitis in pediatric patients and can be used as CSS to assist in making decisions regarding the diagnosis of acute appendicitis in children.

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ROLE OF ULTRASONOGRAPHY FOR EVALUATION OF ACUTE APPENDICITIS: A UNAMID EXPERIENCE

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-1.6214 ◽

2021 ◽

Vol 71 (Suppl-1) ◽

pp. S255-60

Author(s):

Muhammad Tahsin Hashmi ◽

Irum Taqi ◽

Amberin Taqi ◽

Hassan Junaid Sarwar

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Cross Sectional Study ◽

Point Scale ◽

Field Hospital ◽

Cross Sectional ◽

Lower Quadrant ◽

Persistent Symptoms ◽

Operative Findings

Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016. Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography. Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries.The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographicfindings and surgical findings..........

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Influence of Covid -19 on the management of Appendicitis

10.53350/pjmhs211571718 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1718-1721

Author(s):

Mahreen Zahra ◽

Muhammad Kashif ◽

Shafiq Ahmed ◽

Saif Rasool ◽

Ikramullah Khan

Keyword(s):

Acute Appendicitis ◽

Conservative Management ◽

Perforated Appendicitis ◽

Pelvic Abscess ◽

Ethical Review ◽

Generalized Peritonitis ◽

Group A ◽

Group B ◽

Operative Findings ◽

Appendicular Mass

Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic

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Morbidity and Mortality Pattern of Appendicitis in Rural Teaching Hospital of Nepal

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v3i2.30840 ◽

2020 ◽

Vol 3 (2) ◽

pp. 88-94

Author(s):

Suryaman Menyangbo ◽

Gakul Bhatta ◽

Kripa Subedi ◽

Bibek Pun Magar ◽

Harihar Devkota ◽

...

Keyword(s):

Acute Appendicitis ◽

Local Level ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Western World ◽

Mortality Pattern ◽

Cross Sectional ◽

Suspected Appendicitis ◽

Considerable Morbidity ◽

Operative Findings

Background: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. The treatment of acute appendicitis remains a health problem and considerable morbidity and mortality are still associated with it. Perforation, abscess formation, appendicular lump and surgical site of infection are well reported morbidities. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this Midwestern region of Nepal. Methods: This retrospective cross sectional study was carried out in the Karnali academy of health sciences, Jumla Nepal. The data includes the 5 years period from Jan 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication. Results: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix. Two had abscess in 29 cases of appendicular mass. 2 had surgical site infection. Conclusion: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication is the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment are equally feasible for acute appendicitis accordingly the cases presented in the hospital.

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Correlation of Surgical Site Infection (SSI) after appendicectomy with per-operative morphological appearance of appendix.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.02.3231 ◽

2020 ◽

Vol 27 (02) ◽

pp. 251-259

Author(s):

Rehana Firdos ◽

Irfan Haider Abdi ◽

Qambar Ali Laghari ◽

Mujeeb ur Rahman Sahito ◽

Naimatullah Kalhoro

Keyword(s):

Acute Appendicitis ◽

Surgical Site Infection ◽

Cross Sectional Study ◽

Complicated Appendicitis ◽

Pathological State ◽

Site Infection ◽

Cross Sectional ◽

Economic Point ◽

Delay In Diagnosis ◽

Morphological Appearance

Acute appendicitis is the most common cause of emergency abdominal surgery worldwide. Postoperatively, surgical site infection (SSI) occurs in 3% to 60% of appendicectomized patients, depending on pathological state of appendix. SSI is a devastating complication from biologic and economic point of view and has enormous impact on patient’s quality of life. Objectives: To determine the frequency of surgical site infection after appendicectomy in patients presenting as acute appendicitis and correlate it with per-operative morphological appearance of appendix. Study Design: Cross-sectional study. Setting: Department of General Surgery, Liaquat University of Medical and Health Sciences Jamshoro. Period: One year from March 2015 to February 2016. Material & Methods: This study was carried out on 200 patients. All male and female patients above age of 12 years with clinical diagnosis of acute appendicitis or localized peritonitis due to perforated appendix undergoing appendectomy by grid iron incision and whose skin closed primarily by interrupted silk 2/0 stitches were included in the study. Operative findings were recorded and inflammation of appendix was graded into four categories. Postoperatively patients were followed for period of 30 days to check the development of SSI. Results: Out of 200 patients, 42 suffered from SSI (21%). On the basis of per-operative morphological appearance of appendix, uncomplicated appendicitis was significantly high 135(67.5%) than complicated appendicitis 65(32.5%). SSI developed in 12(28.5%) cased of uncomplicated and 30(71.5%) cases of complicated appendicitis. Conclusion: It was not possible to establish a relationship between SSI and per-operative morphological appearance of appendix. Frequency of SSI reported here (21%) is comparable with literature. We recommended that avoiding delay in diagnosis, use of peri-operative antibiotics, sound surgical technique to avoid wound contamination and continuing surveillance is necessary to further reduce SSI rates after open appendicectomy.

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