Appendicolith is Associated with Protracted Abdominal Pain and a High Risk of Appendicular Perforation in Pediatric...

An appendicolith is a hard fecal concretion that can obstruct the appendix, leading to acute appendicitis. This study aimed to determine the prevalence of appendicoliths in pediatric patients with acute and complicated appendicitis. Secondarily, we aimed to evaluate its association with appendicular perforation peritonitis in pediatric patients.

This ambispective observational study was conducted from 2018 to 2023 in a pediatric surgery tertiary care teaching institute. The selected patients (n = 181) were those operated on by the author only. Patients were assigned to the appendicolith (n = 80) and no appendicolith groups (n = 101), and clinical features, laboratory data, ultrasound findings, and final diagnosis were compared. Student's t-test and z-score analyses were used to establish statistical significance.

Out of 181 patients, there were 129 males and 52 females (M: F = 2.48:1). The average age of the patients was 7.75 ± 3.35 years. The mean duration of symptoms was 3.62 ± 2.44 days. The mean leukocyte count was 14.24 ± 6.01 × 10³/μL, and the mean neutrophil% age was 78.18 ± 9.95. The mean maximal diameter of the appendix was 9.16 ± 2.69 mm. The ultrasound evaluation was highly suggestive of appendicitis in 168 (92.82%) patients. There were 80 (44.2%) patients with appendicolith(s). When appendicolith group and the no appendicolith group were compared, statistically significant differences were present in the age at presentation (6.82 ± 3.39 vs. 8.49 ± 3.15), mean duration of symptoms (4.09 ± 2.9 days vs. 3.25 ± 1.94 days), diarrhea (9, 11.25% vs. 2, 1.98%), anemia (30, 37.5% vs. 18, 17.82%), mean maximal diameter of the appendix (9.99 ± 2.82 mm vs. 8.49 ± 2.38 mm), acute (uncomplicated) appendicitis (13, 16.25% vs. 36, 35.64), and complicated appendicitis (67, 83.75% vs. 65, 64.36%). There was no statistically significant difference in the mean leukocyte count and mean neutrophil% age between the two groups. The maximal diameter of appendicolith ≥5 mm (73) in comparison to the maximal diameter of appendicolith <5 mm (7) was significantly associated with a larger percentage of patients with perforated appendicitis (60, 82.19%) than nonperforated appendicitis (3, 42.86%).

The presence of an appendicolith is associated with prolonged abdominal pain and higher rates of appendicular perforation in pediatric patients with acute appendicitis. The size of the largest appendicolith ≥5 mm is an exacerbating factor for appendicular perforation peritonitis.