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Appendiceal fecalith is associated with early perforation in pediatric patients

Diya I Alaedeen1, Marc Cook, Walter J Chwals

  • 1Department of Surgery, Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.

Journal of Pediatric Surgery
|May 20, 2008
PubMed

Insights

Fecaliths in children with appendicitis significantly increase the risk of appendix perforation. Prompt surgery for appendicitis with fecaliths is crucial to prevent complications.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Medical Imaging

Background:

  • Fecaliths, or hardened stool, can obstruct the appendix.
  • Appendiceal obstruction by fecaliths is a known cause of acute appendicitis.

Purpose of the Study:

  • To investigate the association between fecalith presence and appendiceal perforation in pediatric patients.
  • To determine if fecaliths lead to earlier perforation in acute appendicitis.

Main Methods:

  • Retrospective chart review of 388 pediatric patients (<18 years) undergoing appendectomy (2001-2005).
  • Analysis of symptom duration, presentation-to-operation time, and imaging, operative, and pathology findings.
  • Comparison of perforation rates and timing between patients with and without fecaliths.

Main Results:

  • Fecaliths were present in 31% of pediatric appendicitis cases.
  • Appendix perforation occurred in 57% of patients with fecaliths versus 36% without (P < .001).
  • Patients with radiologically identified fecaliths experienced significantly earlier perforation (91 vs 150 hours; P = .036).

Conclusions:

  • Fecalith presence is linked to increased and earlier appendiceal perforation in pediatric acute appendicitis.
  • Expedient appendectomy is recommended for pediatric patients with radiologic evidence of fecaliths.
Abstract

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