Acute appendicitis in children under six years

Abstract

The most common condition in children which requires intra-abdominal surgery is acute appendicitis. 1 With each passing decade the mortality and morbidity of appendicitis has decreased with improvement in diagnotic acumen, safer anesthesia, advances in surgical technic, better pre- and postoperative care, and probably most important the introduction of antibiotics in the 1940's. At the Charity Hospital in New Orleans from 1953 to 1963, in 737 patients under the age of 12 years, Brickman and Leon 2 found a mortality of 0.81 per cent in acute appendicitis. From 1950 to 1960, in 1987 children operated upon for acute appendicitis at the Children's Hospital of Cincinnati 3 the mortality rate was 0.35 per cent. In 1358 cases reviewed by Longino et al. 1 covering the years 1924 to 1957 at the Boston Children's Hospital, there was a 0.07 per cent mortality rate. Despite this progressive decrease in mortality at major medical centers, 284 children died of appendicitis in the United States in 1955. 4 Of these children 102 were less than 5 years old. It is the purpose of this paper to review the experience at the Santa Clara Valley Medical Center in managing appendicitis in children under 6 years, to appraise these methods in terms of mortality and morbidity, and to elucidate the principles of management which contribute to accurate diagnosis and successful treatment.