Is elective appendicectomy is a valuable option in children, with chronic undiagnosed right lower abdominal pain? A prospective study

Abstract

Background:Chronic right lower abdominal pain in children is an enigma with both diagnostic and therapeutic controversies. There are no well-defined management protocols. In this study we have tried to define the role of laparoscopy and elective appendicectomy in these children.Methods: It is a prospective study duration 2 years (2013-15), in which children with chronic right lower abdominal pain, after excluding infective causes of chronic pain all required investigations, children were selected for diagnostic laparoscopy and appendicectomy. Children were following up for relief of pain and complication related to procedure for minimum of 12 months.Results:Total 22 patients were included in study. Male: Female-14:8, average age was 9.2 years. Average duration of symptoms was 12.8 months. Investigations were not helpful in establishing the cause of pain abdomen in these children. On laparoscopy, appendices were found macroscopically abnormal in 14/22 cases, of which 12 show chronic inflammatory changes of histopathology of which 11 showed complete improvement of symptoms in follow up. Eight cases in which appendix were found macroscopically normal, in 6 cases appendicectomy was done. There were no procedure related complications.Conclusions:Laparoscopy in chronic right lower abdominal pain in children with persistent mesenteric lymphadenopathy is useful for both diagnostic and therapeutic purposes. Appendicectomy should be done even if it is macroscopically normal.