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Appendicoliths in Children: Diagnostic Considerations and Postoperative Implications.
Kiran Mahadevappa1, J Asha1, Rajkiran S Raju1
1Pediatric Surgery, St. John's Medical College Hospital, Bangalore, IND.
Cureus
|September 18, 2025
Summary
Appendicoliths, calcified deposits in the appendix, significantly increase the risk of complicated appendicitis in children, leading to higher perforation and abscess rates. Intraoperative detection is crucial for managing these cases effectively.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastrointestinal Health
Background:
- Appendicoliths are calcified deposits within the appendix, frequently causing complicated appendicitis in pediatric patients.
- Their presence correlates with increased risks of appendicular perforation, abscess formation, and necessitates urgent surgical intervention.
- Accurate preoperative and intraoperative detection of appendicoliths is vital for guiding surgical decisions and improving patient outcomes.
Purpose of the Study:
- To assess the diagnostic accuracy of imaging modalities for appendicoliths in children with acute appendicitis.
- To evaluate the surgical management strategies employed for appendicitis associated with appendicoliths.
- To analyze the postoperative outcomes in pediatric patients with appendicoliths.
Main Methods:
- A retrospective chart review was conducted on 198 pediatric patients (<18 years) who underwent appendectomy.
- Data collected included demographics, ultrasonography (USG) and CT imaging findings, intraoperative observations, and postoperative results.
- Comparison was made between patients with and without appendicoliths to identify associated complications and outcomes.
Main Results:
- Appendicoliths were identified in 15.2% preoperatively via USG and 44.9% intraoperatively.
- Children with appendicoliths showed significantly higher rates of perforation (74.2% vs. 14.7%) and abscess formation (91% vs. 17.4%).
- Postoperative wound infection rates were also higher in children with appendicoliths (33.7% vs. 9.2%). Laparoscopic appendectomy was effective with a 6.1% conversion rate.
Conclusions:
- Appendicoliths are a significant risk factor for complicated appendicitis in children.
- Ultrasonography has limited sensitivity for detecting appendicoliths; intraoperative identification is associated with more complications.
- Laparoscopic appendectomy is a safe and effective treatment for appendicitis involving appendicoliths.
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