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Appendiceal location in Japanese children with acute appendicitis: pelvic predominance and diagnostic and operative

Shoma Koga1, Shinichi Noguchi2, Tsuyoshi Kondo2

  • 1Department of Pediatric Surgery, Ehime Prefectural Central Hospital, 83 Kasugamachi, Matsuyama, Ehime, 790-0024, Japan. shoma.h.koga531@gmail.com.

Pediatric Surgery International
|June 15, 2026
PubMed

Insights

In Japanese children with acute appendicitis, the pelvic appendix is most common. The retrocecal appendix presents diagnostic and surgical challenges, with lower ultrasound detection and longer surgery times.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Diagnostic Imaging

Background:

  • Appendiceal location influences acute appendicitis diagnosis and management.
  • Limited pediatric-specific data exists on appendiceal location variations.
  • Understanding anatomical variations is crucial for surgical planning in children.

Purpose of the Study:

  • To evaluate appendiceal location in Japanese pediatric patients with acute appendicitis.
  • To examine the clinical implications of different appendiceal locations.
  • To assess diagnostic and surgical challenges associated with specific appendiceal positions.

Main Methods:

  • Retrospective review of 105 pediatric patients undergoing appendectomy (Jan 2015-Mar 2024).
  • Modified Wakeley classification used for intraoperative appendiceal location assessment.
  • Comparison of clinical presentation, ultrasonographic identification, and surgical outcomes across location groups.

Main Results:

  • Pelvic position (51.4%) was the most frequent appendiceal location.
  • Retrocecal position (20.0%) showed significantly lower ultrasonographic identification rates (61.1% vs. 85.1%).
  • The retrocecal group experienced longer surgical durations (median 90 min vs. 58 min).

Conclusions:

  • Pelvic appendiceal location is most common in Japanese children with acute appendicitis.
  • Retrocecal appendicitis poses diagnostic challenges due to lower ultrasound detection rates.
  • Retrocecal appendicitis requires longer surgical times, indicating increased technical difficulty.
Abstract

Keywords:
Acute appendicitisAppendiceal locationLaparoscopyPediatric surgeryUltrasonography

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