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[The chronically altered appendix in children. Cooperative work of the Austrian Society for Pediatric Surgery]
Insights
The chronically altered, non-inflamed appendix is not an illness but a resolved inflammation. Early surgical intervention is recommended due to high perforation rates in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Context:
- Multicentric study evaluating pediatric patients undergoing appendectomy.
- Focus on appendices without acute inflammation at operation.
Purpose:
- To investigate the significance of chronically altered, non-inflamed appendices.
- To determine if these findings represent a distinct pathological entity or a sequela of resolved inflammation.
- To inform surgical decision-making in cases of suspected appendicitis.
Summary:
- Evaluated 2-29 children's data; 31.1% showed macroscopic scarring, 13.7% had other findings.
- Patho-histological examination of 1194 appendices revealed 36.4% negative, 37.7% scarring, 15.0% oxyuriasis, 10.4% coproliths.
- Analysis indicated chronically altered appendices result from spontaneously arrested inflammation, not a primary disease.
Impact:
- Supports the principle of 'in dubio pro operatione' (when in doubt, operate) for pediatric appendectomies.
- Highlights the diagnostic challenges and the need for surgical intervention despite non-inflamed appearance.
- Contributes to understanding appendiceal pathology and optimizing surgical outcomes in children.
Abstract:
In this multicentric study the anamnestic data and parents questionaires of 2-29 children were evaluated, whose appendix vermiformis at the time of operation showed no signs of inflammation. 31,1% macroscopically showed cicatrisation or fasciation, in 13,7% other enteral or gynaecological (1%) findings were present. In 1194 of the cases of patho-histological examination of the appendix had been made of which 36.4% were negative, 37.7% showed cicatrisation, 15,0% oxyuriasis and 10,4% coproliths. In the discussion of the significance of the chronically altered non-inflamed appendix we compared patients with and without macroscopical or microscopical alterations. We came to the conclusion that the probability-index as to sex, duration of symptoms, complexity of symptoms, incidence of postoperative well-being, proved the chronically altered appendix not to be an illness per se, but the result of spontaneously arrested inflammation. Since the rate of children admitted with a perforated appendix is high (15-20%) in comparison with the rate of complications after removal of non-inflamed appendices (2,9%), we believe that according to the diagnostical problems the principle can be maintained: in dubio pro operatione.