[Diagnostic value of the rectal examination and the difference in axillo-rectal temperatures in acute appendicitis in childhood]
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J Koudelka1, J Preis, M Králová
1Odĕlení dĕtské chirurgie FNaP, Hradec Králové.
Insights
Rectal exams in children with suspected appendicitis show pain in the Douglas space is unreliable for diagnosis. The axillo-rectal temperature difference is also not a useful diagnostic indicator for acute appendicitis.
Area of Science:
- Pediatric Surgery
- Diagnostic Accuracy
- Symptom Evaluation
Context:
- Acute appendicitis is a common surgical emergency in children.
- Diagnostic challenges persist, leading to negative laparotomies.
- Rectal examination is a traditional but debated diagnostic tool.
Purpose:
- To evaluate the diagnostic utility of pain in the Douglas space during rectal examination for acute appendicitis in children.
- To assess the contribution of axillo-rectal temperature difference in diagnosing acute appendicitis.
- To correlate findings with surgical outcomes, including negative laparotomies.
Summary:
- In 402 children operated on for suspected appendicitis, marked Douglas space pain was present in 53.6% of confirmed appendicitis cases, while absent in 31.2%.
- Conversely, absence of pain was more frequent in negative laparotomies.
- An axillo-rectal temperature difference of ≥1°C was three times more frequent in negative laparotomies than in acute appendicitis, suggesting limited diagnostic value.
Impact:
- Findings suggest that while rectal examination is recommended for suspected acute abdomen, pain in the Douglas space has limited impact on reducing negative laparotomies.
- The axillo-rectal temperature difference is deemed practically useless for diagnosing acute appendicitis in this pediatric cohort.
- Highlights the need for improved diagnostic strategies beyond traditional physical exam findings.
Abstract:
The authors deal with the importance of pain in the Douglas space during rectal examination and the contribution of the axillo- rectal difference in temperature in the diagnosis of acute appendicitis in a group of 402 children operated on who had the above preoperative diagnosis. Marked pain in the Douglas space was recorded in 53.6% children and complete absence of pain in 31.2% of the children with acute appendicitis proved at operation. In children where so-called negative laparotomy was performed this ratio was reversed. When evaluating the axillo-rectal difference in temperature the authors reached the paradoxical conclusion that an obviously physiological difference in the axillo-rectal temperature (up to 0.5 degrees C) was slightly more frequent in acute appendicitis than in negative laparotomy. An obviously pathological difference (1 degrees C or more) was three times more frequent in patients with negative laparotomies than in acute appendicitis. Next the authors discuss views reported in the literature where data on the asset of rectal examination in acute appendicitis vary between 2.9-73%. In the conclusion the authors recommend rectal examinations in all children with suspicion of any type of acute abdomen, however, taking into account that pain in the Douglas space will contribute only little to the reduction of the number of negative laparotomies. They consider assessment of the axillo-rectal difference in temperature practically useless.