Acute appendicitis in preschoolers: a study of two different populations of children

Stefanos Gardikis,Alexandra Giatromanolaki,George Vaos,Gregorios Tripsianis,Efthimios Sivridis,Katerina Kambouri

doi:10.1186/1824-7288-37-35

Stefanos Gardikis, Alexandra Giatromanolaki + Show 4 more

Open Access

https://doi.org/10.1186/1824-7288-37-35

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Abstract

ObjectiveTo assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region.MethodsOver a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children) and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue.ResultsAcute appendicitis of preschoolers developed more frequently in Muslims (39.4%) than in Christians (17.7%; p < 0.001). The lack of inside toilet facilities at home, overcrowded living conditions, living in rural areas, and the amount of appendix lymphoid tissue were significantly more frequent among the Muslim preschool children (p < 0.05), while there were no statistically significant differences between Muslim and Christian children with regard to gender, the family history of acute appendicitis, or the vegetable consumption (p > 0.05).ConclusionsIn our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.

Highlights

Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention during childhood, accounting for 1-8% of children who present to the pediatric emergency room with acute abdominal pain [1]
Of the 352 children who had undergone appendectomy, 23 (8 Muslim children (MC) and 15 Christian Orthodox children (COC); 6 and 7 of them, respectively, aged ≤ 5 years) were excluded from further analysis because the histology of the appendix was negative for acute inflammation
Regarding the annual incidence of acute appendicitis in preschool- and school-aged children according to religious affiliation, it was found that the annual incidence of acute appendicitis among preschoolers was 6.1/10,000 MC and 3.8/10,000 COC, respectively, whereas the incidence among school-age children was 6.4/10,000 MC and 12.7/10,000 COC, respectively

Summary

Introduction

Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention during childhood, accounting for 1-8% of children who present to the pediatric emergency room with acute abdominal pain [1]. While surgical treatment of acute appendicitis is well established, the etiology and pathogenesis of this condition remains unclear, but appears to be multifactorial. Obstruction of the appendiceal lumen by a fecalith and hyperplasia of the lymphoid follicle in the appendiceal wall have been proposed as common causes of acute appendicitis [5]. Primary bacterial and viral infections [6], blunt abdominal trauma, and ischemia of the appendix [7] have been investigated as possible causes. It has been suggested that there is a genetic predisposition [8] or a type I hypersensitivity reaction involved in the development of acute appendicitis [9]

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