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

Chandrashekar S.; Lokesh M. G.; Avinash S. R.

doi:10.18203/2349-2902.isj20185020

Authors

Chandrashekar S. Department of General Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
Lokesh M. G. Department of General Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
Avinash S. R. Department of General Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20185020

Keywords:

Acute appendicitis, Alvarado score, Perforation

Abstract

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.

Metrics

Metrics Loading ...

References

Augustin T, Cagir B, VanderMeer TJ. Characteristics of perforated appendicitis: effect of delay is confounded by age and gender. J Gastrointestinal Surg. 2011;15(7):1223.

Hasbahçeci M, Erol C, Törü M, Şeker M. Effect of surgeon’s judgement on the diagnosis of acute appendicitis. Turkish J Surg/Ulusalcerrahidergisi. 2014;30(1):22.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-25.

4.Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Report. 2010;(29):1-20, 24.

Davenport M. Acute abdominal pain in children. BMJ. 1996;312:498-501.

Horwitz JR, Gursoy M, Jaksic T, Lally KP. Importance of diarrhea as a presenting symptom of appendicitis in very young children. Am J Surg. 1997;173:80-2.

Irish MS, Pearl RH, Caty MG, Glick PL. The approach to common abdominal diagnosis in infants and children. PediatrClin North Am. 1998;45:729-72.

Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers for acute appendicitis in children: are they helpful. J Pediatr Surg. 2007;42:773-6.

Bansal S, Banever GT, Karrer FM, Partrick DA. Appendicitis in children less than 5 years old: influence of age on presentation and outcome. Am J Surg. 2012;204:1031-5.

Marzuillo P, Germani C, Krauss BS, Barbi E. Appendicitis in children less than five years old: A challenge for the general practitioner. World J Clin Pediatrics. 2015;4(2):19.

Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2013;66:95-104.

Bansal S, Banever GT, Karrer FM, Partrick DA. Appendicitis in children less than 5 years old: influence of age on presentation and outcome. Am J Surg. 2012;204:1031-5.

Pogorelić Z, Biočić M, Jurić I, Milunovic KP, Mrklic I. Acute appendicitis as a complication of varicella. Acta Medica (Hradec Králové). 2012;55:150-2.

Pogorelić Z, Stipić R, Druzijanić N, Perko Z, Grandic L, et al. Torsion of epiploic appendage mimic acute appendicitis. Coll Antropol. 2011;35:1299-302.

Perko Z, Bilan K, Pogorelić Z, Tomic S, Vilovic K, Krnic D, et al. Acute appendicitis and ileal perforation with a toothpick treated by laparoscopy. Coll Antropol. 2008;32:307-9.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.

McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007;25:489-93.

Bhatt M, Joseph L, Ducharme F. Prospective validationof the pediatric appendicitis score in a Canadian pediatric emergencydepartment. Acad Emerg Med. 2009;16:591-6.

Subotic AM, Sijacki AD, Dugalic VD, Antić AA, Vuković GM, Vukojević VS, et al. Evaluation of the Alvarado score in the diagnosis of acute appendicitis. Acta Chir Iugos. 2008;55:55-61.

Arian GM, Sohu KM, Ahmad E, Haider W, Naqi SA. Role of Alvarado score in diagnosis of acute appendicitis. Pak J Surg. 2001;17:41-6.

Hsiao KH, Lin LH, Chen DF. Application of the MANTRELS scoring system in the diagnosis of acute appendicitis in children. Acta Paediatr Taiwan. 2005;46:128-31.

Sun JS, Noh HW, Min YG, Lee JH, Kim JK, Park KJ, et al. Receiver operating characteristic analysis of the diagnostic performance of a computed tomographic examination and the Alvarado score for diagnosing acute appendicitis: emphasis on age and sex of the patients. J Comput Assist Tomogr. 2008;32:386-91.