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Pediatric appendicitis in a developing country: what are the clinical predictors and outcome of perforation?
Chin Fang Ngim1, Kia Fatt Quek2, Amreeta Dhanoa3
1Department of Pediatrics, Johor Bahru Clinical School, Monash University Malaysia, 80100 Johor Bahru, Malaysia ngim.chin.fang@monash.edu.
Insights
Pediatric appendicitis perforation is linked to longer symptom duration and higher white blood cell counts. Staphylococcus aureus infections in perforated appendicitis cases correlate with increased complications.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Appendicitis is a common surgical emergency in children.
- Perforation is a significant complication associated with increased morbidity.
Purpose of the Study:
- To identify risk factors for appendiceal perforation in children.
- To investigate outcomes and complications following emergency appendicectomy for perforated appendicitis.
Main Methods:
- Retrospective cross-sectional study of children under 13 years old.
- Analysis of appendicectomy cases from a Malaysian hospital in 2007.
- Histological confirmation and intra-operative pus culture analysis.
Main Results:
- 52% of appendicectomies were for perforated appendicitis.
- Perforation associated with longer symptom duration, higher white cell and neutrophil counts, and extended recovery periods.
- Escherichia coli was the most common bacterial isolate; Staphylococcus aureus was linked to severe pyogenic complications.
Conclusions:
- Prolonged symptoms and elevated white blood cell counts are indicators of appendiceal perforation in children.
- Staphylococcus aureus presence in surgical cultures signifies a higher risk of post-operative complications.
Objectives:
This study explored the risk factors and outcomes associated with perforation in children who underwent emergency appendicectomies.
Methods:
A retrospective cross-sectional study was conducted on children <13 years old who underwent appendicectomies in a Malaysian hospital in 2007.
Results:
One hundred thirty-four children underwent appendicectomies of which 118 were confirmed histologically. Sixty-one (52%) were perforated. Children with perforation had significantly longer duration of symptoms (p < 0.001), higher white cell count and absolute neutrophil counts (p = 0.013), with longer intra-operative period (p < 0.001) and post-operative recovery period (p < 0.001). Of the 52 samples of pus collected intra-operatively, 37 (71.1%) yielded positive cultures that were predominantly Escherichia coli (n = 27). Both the patients who had Staphylococcus aureus cultured from pus collected intra-operatively had significant pyogenic complications (scrotal pyocele and intra-abdominal abscess).
Conclusion:
Children whose appendicitis were perforated had longer duration of symptoms, higher white cell counts and absolute neutrophil counts. Those with S.aureus cultured from intra-operative pus appeared to suffer more complications.
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