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Appendicolith and inflammatory burden in pediatric acute appendicitis: an independent association
Meryem Anayurt1, Serpil Sancar2, Sabriye Dayı2
1Department of Pediatric Surgery, University of Health Sciences, Bursa City Hospital, Doğanköy Mahallesi, 16110 , Bursa, Turkey. mrymanyrt@gmail.com.
Insights
Appendicoliths in children with appendicitis indicate a higher risk of perforation and complications. Early detection may influence treatment strategies for pediatric appendicitis.
Area of Science:
- Pediatric Surgery
- Radiology
- Gastroenterology
Background:
- Appendicitis is a common surgical emergency in children.
- Appendicoliths, calcified deposits in the appendix, are often incidental findings.
- Their clinical significance in pediatric appendicitis requires further elucidation.
Purpose of the Study:
- To analyze radiological features of appendicoliths in pediatric appendicitis.
- To determine the association between appendicoliths and patient demographics, clinical presentation, and laboratory findings.
- To evaluate the impact of appendicoliths on surgical and postoperative outcomes in children.
Main Methods:
- Retrospective analysis of 711 pediatric patients undergoing appendectomy for acute appendicitis.
- Patients were categorized based on the presence or absence of appendicoliths on preoperative imaging.
- Comparison of demographic, clinical, laboratory, surgical, and postoperative data between groups.
Main Results:
- Appendicoliths were identified in 17.4% of patients.
- Appendicolith presence correlated with significantly higher rates of perforated appendicitis (47.6% vs. 23.5%).
- Patients with appendicoliths showed elevated CRP and WBC levels, increased drain requirements, and longer hospital stays.
Conclusions:
- Appendicoliths in pediatric appendicitis are linked to increased inflammation and complicated disease.
- Appendicolith presence is an independent predictor of perforation.
- Prospective studies are needed to define the role of appendicoliths in clinical decision-making for pediatric appendicitis.
Purpose:
This study aimed to evaluate the radiological characteristics of appendicoliths detected on preoperative imaging and to assess their association with demographic, clinical, laboratory, surgical, and postoperative outcomes in children with acute appendicitis.
Methods:
Data from 711 pediatric patients who underwent appendectomy for acute appendicitis between July 2019 and August 2024 were retrospectively analyzed. Patients were grouped according to the presence of appendicolith on preoperative imaging, and postoperative outcomes were compared.
Results:
Appendicolith was detected in 124 (17.4%) patients; age and gender distribution were similar between groups. The rate of perforated appendicitis was significantly higher in patients with appendicoliths (47.6% vs. 23.5%; p < 0.001). CRP and WBC levels were significantly higher in the presence of appendicoliths (p < 0.001 for both). Appendicolith presence was associated with increased drain requirement (29.8% vs. 13.5%; p < 0.001) and longer postoperative hospital stay (median 5 vs. 4 days; p < 0.001). In multivariable analysis, appendicolith presence remained independently associated with perforation (adjusted OR: 2.53, 95% CI: 1.51-4.25).
Conclusion:
Appendicolith in pediatric acute appendicitis was associated with increased inflammatory burden and a higher likelihood of complicated disease. However, given the retrospective design, prospective studies are required to clarify its role in clinical decision-making.
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