ACUTE APPENDICITIS IN CHILDREN

Abstract

Objective: The study was conducted to identify clinical features significantlyassociated with histopathologically proven appendicitis in children. Design: Cross-SectionalObservational. Place and Duration of study: This study was conducted in Department ofPaediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012.Patients and methods: Children aged 2 to 14 years who underwent appendectomy for acuteappendicitis during the study period were included. Patients who had appendectomy for anyreason other than appendicitis were excluded. Presenting symptoms, signs, hospital course ofpatients and histopathological diagnosis were recoded. Data was analyzed by using SPSS.Sensitivity, specificity, positive predictive value and negative predictive value for each symptomand sign were calculated. Results: Out of 1420 patients who were evaluated during the studyperiod for acute abdominal pain, 70(5%) were diagnosed with acute appendicitis. Four patientsleft against medical advice so 66 patients were studied. Patients were divided into acuteappendicitis and non-inflamed appendix group on the basis of histopathology of resectedappendix. Acute appendicitis was confirmed histologically in 43 (65%) cases and perforatedappendicitis was found in 8 (12%). No evidence of acute inflammation was found in 15 (22%)cases. Among clinical features only involuntary guard (p-value 0.01) and rebound tenderness(p-value 0.004) were significantly different among acute appendicitis and non-inflamed appendixgroup. Total leukocyte count more than 11,000 was significantly higher in acute appendicitisgroup. Conclusions: The cornerstone of diagnosis of acute appendicitis in children is thoroughhistory and meticulous physical examination. Involuntary guard, rebound tenderness and totalleukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases ofappendicitis.