Pericardial disease as a rare complication of pediatric appendicitis: a systematic literature search

Bibek Saha,Kazuyoshi Aoyama,Mark Levine,Marina Englesakis,Maria-Alexandra Petre,James Robertson

doi:10.1186/s40981-020-00395-8

Abstract

BackgroundClassic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae.MethodsWe conducted a comprehensive systematic literature search of case reports detailing pericardial disease as a rare complication of pediatric appendicitis through MEDLINE, Embase, and Cochrane Databases. Inclusion criteria was that the patient must be < 18 years old and present with both pericardial disease and appendicitis.ResultsOur search yielded 7 cases with an average age of 10.3 ± 3.9 years old. The cases involved cardiac tamponade, pericarditis, and/or pericardial effusion. Five cases were diagnosed with appendicitis before complicated by pericardial disease. Most cases had an infectious component, but a majority had negative pericardial fluid cultures. Pleural effusion and abdominal abscesses were other common complications of pediatric appendicitis.ConclusionAwareness of this uncommon relationship may have prognostic value as this may facilitate appropriate management of pericardial effusions, tamponade, and/or appendicitis.

Highlights

Classic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae
We reported of a unique case with cardiac tamponade complicating perforated appendicitis in a 7-year-old girl [5] prompting us to investigate the relationship between pericardial disease and pediatric appendicitis further
Search strategies (Supplementary online resource 1) were built to contain sets of terms reflecting our topic of interest including pericardial disease, appendicitis, and the patient population

Summary

Introduction

Classic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae. Many children without appendicitis present with these classic symptoms [2]. We reported of a unique case with cardiac tamponade complicating perforated appendicitis in a 7-year-old girl [5] prompting us to investigate the relationship between pericardial disease and pediatric appendicitis further. Given that pericardial disease could cause significant hemodynamic instability during general anesthesia, we aimed to summarize anesthetic management of the eligible cases. We present a comprehensive systematic literature search of (2020) 6:89 case reports detailing pericardial disease as a rare complication of appendicitis in the pediatric population and suggestions regarding management

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