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ACUTE APPENDICITIS IN CHILDREN ADMITTED TO ZEWDITU MEMORIAL HOSPITAL
Insights
Delayed treatment of acute appendicitis in children significantly increases perforation risk. Longer symptom duration correlates with higher perforation rates, increased complications, and extended hospital stays.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Emergency Medicine
Background:
- Acute appendicitis is the most frequent cause of acute abdomen in pediatric patients.
- The duration of symptoms before treatment may influence the rate of appendiceal perforation.
Purpose of the Study:
- To characterize the clinical presentation of acute appendicitis in children.
- To evaluate symptom duration as a predictor of perforation in pediatric appendicitis.
Main Methods:
- Retrospective analysis of medical records for 322 children under 15 years old.
- Intraoperative diagnosis of acute appendicitis between September 2006 and August 2010.
Main Results:
- The incidence of perforation increased with symptom duration: 4.1% (<24 hrs), 10.2% (24-48 hrs), and 45.3% (>48 hrs).
- Perforated appendicitis cases had longer symptom duration (5.2 days vs. 2.5 days) and hospital stays (8.4 days vs. 3.6 days) compared to non-perforated cases.
- Higher rates of postoperative wound infection (31% vs. 1.9%) and mortality were observed in perforated cases.
Conclusions:
- Acute appendicitis is common in children, particularly those aged 10-14 years.
- Symptom duration is a critical risk factor for appendiceal perforation in children.
- Delayed presentation leads to increased morbidity, mortality, and prolonged hospitalization for perforated appendicitis.
Background:
Acute appendicitis is the most common cause of acute abdomen in children. The rate of appendicular perforation may be related to duration from the onset of symptom presentation to treatment.
Objective:
To describe the clinical characteristics and assess symptom duration as a risk factor for perforation in children with acute appendicitis. PATENTS AND METHODS: A retrospective analysis of medical records of 322 children under 15 years of ages with intraoperative diagnosis of acute appendicitis between the periods of September 2006 and August 2010.
Results:
Acute appendicitis accounted for 87.5% of all cases of acute abdomen during the study period. Two hundred patients were boys and 122 patients were girls giving male to female ratio of 1.6:1. The mean and median ages were 10.4 and 11 years respectively. The youngest patient was 3 years old. The peak age range was 10-14 years. The most common presenting symptoms were abdominal pain (100%), anorexia (85.1%), vomiting (83.9%), and fever (82.3%). Right lower quadrant tenderness was the leading physical finding observed in 83.9% of patients. The mean duration of symptoms in children with non-perforated appendicitis was 2.5 days whereas the mean duration of symptoms in children with perforated appendicitis was 5.2 days. The mean length of hospital stay in children with non-perforated appendicitis was 3.6 days whereas the mean length of hospital stay in children with perforated appendicitis was 8.4 days. Leucocytosis was observed in 74.5% of children and the mean leucocyte count was 13150/mm3. The incidences of perforation if symptoms were present for less than 24 hours, 24-48 hours and more than 48 hours were 4.1%, 10.2%, and 45.3%, respectively. Postoperative wound infection was observed in 1.9% and 31% of children with non-perforated and perforated appendicitis, respectively. Two children died in the hospital.
Conclusion:
Acute appendicitis was the commonest cause of acute abdomen in children. It was more prevalent in children aged 10-14 years. The commonest presenting symptoms and signs were abdominal pain, anorexia, vomiting, and fever and right lower quadrant tenderness. The risk of perforation is directly proportional to the duration of illness at presentation. Perforated appendicitis was associated with increased morbidity, mortality and prolonged hospital stay.