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[Acute appendicitis in children]

M Gonçalves1, A P Martins, M J Leal

  • 1Serviço de Cirurgia Pediátrica, Hospital de Santa Maria, Lisboa.

Acta Medica Portuguesa
|August 1, 1993
PubMed
Summary
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Acute appendicitis in children often presents late, with abdominal pain and anorexia being common symptoms. Early surgical intervention is crucial to prevent complications like gangrene and abscesses, despite a low rate of misdiagnosis.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Infectious Disease

Context:

  • Retrospective analysis of 207 pediatric appendicitis cases from 1987-1989.
  • Appendicitis represented 97% of emergency laparotomies at Santa Maria Hospital.
  • Focus on clinical presentation, diagnostic challenges, and management outcomes.

Purpose:

  • To evaluate the clinical characteristics, diagnostic accuracy, and complications of acute appendicitis in pediatric patients.
  • To assess the impact of delayed presentation on disease stage and outcomes.
  • To review antibiotic use and surgical management strategies.

Summary:

  • Most frequent symptoms included abdominal pain (99%) and anorexia (86%).
  • 35.8% of cases were referred for surgical evaluation over 48 hours after symptom onset.

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  • Surgery was performed on 129 patients (62.4%) with advanced appendicitis; 7.2% of cases were misdiagnosed (follicular hyperplasia or normal histology, 4 with parasitic eggs).
  • Cefoxitin was the primary antibiotic used pre- and postoperatively.
  • 19 complications (9.2%) occurred, including abscesses and obstructions, with 4 reoperations and no mortality.

    • Impact:

    • Highlights the importance of timely diagnosis and surgical intervention in pediatric appendicitis.
    • Identifies diagnostic challenges, including non-appendicitis cases with similar presentations.
    • Provides data on complication rates and management effectiveness in a historical cohort.