Acute Appendicitis In Children Research Articles

Relationship of eating habits to acute appendicitis in children: a literature review

Introduction: Appendicitis is the inflammation of appendix vermiformis and is designated a national health priority issue by the Ministry of Health. Obstruction of the appendicitis lumen is the main etiology of acute appendicitis, and one of the risk factors is eating habits. This study aimed to determine how eating habits are at risk of causing appendicitis in children. Eating habits that were becoming the focus of this study are fiber intake, water consumption, and fast food. Methods: This research is a literature study with the scoping review method, compiled based on PRISMA-ScR. Results: The results obtained are four works of literature stating that low fiber intake and inadequate water consumption in children have a relationship with acute appendicitis, and one piece of literature states that there is no correlation. However, the consumption of fast food has no direct relationship to the occurrence of appendicitis. Conclusion: In this review, a low-fiber diet was significantly correlated with an increased incidence of appendicitis in children.

The clinical value of IMA and SCUBE1 in the diagnosis of acute appendicitis in children

Objectives. This study aims to show the clinical value of ischemia-modified albumin (IMA) and Signal Peptide, Complementary C1r/C1s, Uegf and Bmp1–Epidermal Growth Factor Like Domain Containing 1 (SCUBE1) protein in pediatric appendicitis. Methods. Eighty-one pediatric patients hospitalized in the pediatric surgery ward with acute appendicitis and a control group of 62 pediatric patients with unspecific abdominal pain were included in this prospective case-control study. Thirty-nine patients whose pathology specimens confirmed acute appendicitis made up the final appendicitis group. Results. Patients with appendicitis had higher IMA (p<0.001) and SCUBE1 (p<0.001) levels than the control group. In receiver operating characteristic (ROC) analysis, areas under the curve (AUC) were 0.991 (sensitivity=97.4%, specifity=100%, positive likelihood ratio (+LR) infinity, negative likelihood ratio (-LR)=0.03, positive predictive values (+PV)=100%, negative predictive value (-PV)=98.3% for IMA and 0.803 (sensitivity = 89.7%, specificity =64.5%, +LR=2.53, -LR=0.16, +PV=61.4%, -PV=90.9%) for SCUBE1. Conclusions. The present study shows that IMA may be a reliable marker for a more accurate diagnosis of appendicitis. SCUBE1 can be used to exclude diagnosis if used in combination with other laboratory and clinical data.

The Role of Platelet Indices, Red Cell Distribution Width and the Ratios of Neutrophil to Lymphocyte, Platelet to Lymphocyte and Lymphocyte to C-reactive Protein as Markers for the Diagnosis of Acute Appendicitis in Children

The Role of Platelet Indices, Red Cell Distribution Width and the Ratios of Neutrophil to Lymphocyte, Platelet to Lymphocyte and Lymphocyte to C-reactive Protein as Markers for the Diagnosis of Acute Appendicitis in Children

Gastrointestinal manifestations of COVID-19-associated multisystem inflammatory response syndrome in children

Aim: analysis of the course of SARS-Cov-2-associated multisystem inflammatory response syndrome (MIS-C) with gastrointestinal disorders in comparison with MIS-C without gastrointestinal manifestations in children of the Lviv region. Materials and methods. Analysis of medical records of children under the age of 15 years who were treated at the CNE LRC LRCCH “ОHMATDYТ” with a diagnosis of MIS-C associated with SARS-Cov-2. Results. Gastrointestinal manifestations of MIS-C associated with SARS-Cov-2 were observed in 52.38 % of children, and other symptoms in this group of patients included headache and cough. Levels of specific SARS-Cov-2 IgG did not differ significantly in children with and without gastrointestinal symptoms. In contrast, patients with MIS-C without gastrointestinal manifestations were more likely to have myocardial dysfunction, requiring longer hospitalization. Children with gastrointestinal manifestations of MIS-C were more likely to be obese. Conclusions. The severity of the clinical course of multi-inflammatory systemic response syndrome associated with SARS-Cov-2 did not depend on the severity and time elapsed since acute coronavirus disease and was not associated with gastrointestinal manifestations, which were observed in 52.38 % of patients. Cough and headache, even in the absence of such typical MIS-C manifestations as rash, scleral changes and swelling of the extremities, could be symptoms allowing a surgeon to think about conservative management of a patient with acute abdominal syndrome. MIS-C associated with SARS-Cov-2 should be included in clinical protocol guiding management of acute appendicitis in children.

The Possibilities of Complex Echography in the Diagnosis of Acute Appendicitis in Children

Acute appendicitis (OA) is currently the most common urgent disease of the abdominal cavity and occurs in 2-5 people per 1,000 populations. In the Republic of Uzbekistan, this indicator is 3.05 people per 1,000 populations according to the statistical materials on the activities of healthcare institutions of the Republic of Uzbekistan. Children with acute appendicitis were admitted to the hospital with complaints lasting up to 12 hours - 110 (46.6%), from 12 to 24 hours - 49 (20.8%), from 24 to 48 hours - 43 (18.2%) and from 48 hours or more - 34 (14.4%) children. In children with a disease duration of more than a day, only destructive forms of inflammation of the vermiform process were recorded. After 24 hours from the onset of clinical manifestations, children with phlegmonous and gangrenous appendicitis were admitted. Various variants of the location of the cecum and the vermiform process made it necessary to thoroughly examine the entire abdominal cavity. In 15 children, the diagnosis of OA was excluded due to the presence of other acute abdominal diseases. Thus, ovarian apoplexy was observed in 3 girls, pelvic pain syndrome caused by various gynecological diseases in 5 girls, acute pancreatitis with diffuse pains in 2, an attack of renal colic on the right in 5 children. Thus, the study of the features of the course of various clinical forms of acute appendicitis in children allowed to increase the effectiveness of diagnosis and improve the results of treatment. Ultrasound examination is a promising and safe method of diagnosing acute appendicitis, which allows to bring the effectiveness of complex diagnostics to 100% and is of important importance when choosing treatment tactics.

Ультрасонографія в діагностиці гострого апендициту у дівчат

Acute appendicitis is the most common cause of abdominal pain, which requires immediate surgical intervention in children and is a truly urgent pathology of the gastrointestinal tract. Preliminary diagnosis is made primarily on the basis of clinical data, however, in the course of further examination an integral part of the diagnostic process are additional research methods such as general blood tests, ultrasound examination of the abdominal cavity. Purpose - to determine the complex diagnostic significance of the ultrasound method of research in patients with abdominal pain. Materials and methods. A retrospective analysis of 200 medical records of inpatients treated at the Vinnytsia regional clinical hospital (Ukraine) for appendicitis in 2021 was conducted. Our study was conducted in the conditions on the basis of the analysis of medical records of inpatients. During the above-described period, ultrasound examination was performed in Vinnytsia regional clinical hospital in 200 girls with abdominal pain. Ultrasound examination was performed with Doppler scanning on ultrasound machines «SAMSUNG H 60» (South Korea) and «SAMSUNG» LS 22 EMU 1 HS (Seoul. Korea, 2016). The age distribution of girls was as follows: 0-3 years - 8 (4%) girls, 4-12 years - 86 (43%) children, 13-18 years - 106 (53%) girls. Results. Simultaneous comparison of the dynamics of local changes in the clinical picture, hemogram, the amount of endogenous intoxication and visual findings on ultrasound of the abdominal cavity avoids unwarranted surgery in patients with abdominal pain and direct the doctor to the correct tactical course in doubtful cases. Conclusions. Only a properly collected history, assessment of physical and clinical and laboratory parameters and data of laboratory methods of examination, the involvement of the necessary narrow specialists can avoid mistakes in the diagnosis of acute appendicitis in children. It is expedient and justified in the diagnostic assessment of the clinical picture in case of suspicion of acute appendicitis to compare the indicators of the total index of endogenous intoxication with the ultrasound method of appendix removal in the dynamics of the pathological process. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ultrasound, appendicitis, diagnosis, surgery.

Dynamic Thiol / Disulfide Homeostasis a Promising New Marker in the Diagnosis of Acute Appendicitis in Children

Objectives: One of the most common emergency surgery in pediatric surgery is due to acute appendicitis (AA). The diagnosis of AA is usuallymade using with the clinical score using clinical signs, symptoms, and laboratory tests. But symptoms and signs are not always typical, andthis situation put clinician in a compelling situation. The range of misdiagnosis of AA is between 28-57 % between 2-12 years old children.Thiol/ Disulphide homeostasis is an important indicator of oxidative stress and inflammation. This study is aimed to evaluate and compare thefeasibility of thiol/disulphide levels in pediatric patients with AA and abdominal pain (AP).Methods: In this case-control study three different group established with 25 healthy participants (NCG), 25 patients with abdominal pain(PCG), and 25 with AA (AAG). Demographics, white blood cell count, neutrophil-lymphocyte counts, hemoglobin, platelet, mean plateletvolume, C-reactive protein, total thiol (TT), native thiol, (NT) and disulphide (DS) levels measure through blood samples.Results: According to our result, the level of NT were significantly lower in AAG when compared with NCG and PCG (p<0.001). DS levels weresignificantly higher in AAG than in NCG (p<0.001). CRP levels were significantly higher in both PCG and AAG than those of NCG p<0.001).Conclusion: Thiol/disulphide homeostasis is a valuable method to examine acute appendicitis in the pediatric patients. Fluctuations of thiol/disulphide homeostasis could be used as a marker in daily clinical practice for diagnosis of appendicitis.

The Performance of Hematological Parameters for Diagnosis of Acute Appendicitis in Children

Early diagnosis of pediatric appendicitis is still difficult to make and 30-40% of cases do not show typical classic symptoms. The negative appendectomy rate and the risk of perforation reach 20% so that new, easy, inexpensive and accurate additional examination is needed. This study aimed to compare platelet distribution width (PDW) and mean platelet volume (MPV) values of appendicitis and control patients. This study is retrospective case control study. Differences in MPV and PDW levels in patients with appendicitis and controls were analyzed with a t-test and determination of sensitivity, specificity and accuracy of the two markers in appendicitis diagnosis were performed by ROC analysis The mean MPV appendicitis was significantly lower (p <0.05) compared to controls (8.3 ± 1.9; 9.2 ± 1.5) while PDW of appendicitis patients did not differ significantly from controls (10.4 ± 1, 4, 10.7 ± 2.4; p> 0.05). AUC MPV as a diagnostic tool for appendicitis 0.619 with a normal limit of 6.6 fl has a sensitivity of 90% and specificity of 30%. MPV can be used for the diagnosis of appendicitis with a normal limit of 6.6 fl having a sensitivity of 90% and specificity of 30%. There was no significant difference between PDW of appendicitis patients with controls. There was no significant difference between MPV levels of patients with simple appendicitis and complications.
 Keywords: Appendicitis, MPV, PDW, Platelet

Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children.

Acute appendicitis (AA), the most common abdominal emergency disease, is one of the most important causes of hospitalization of children. Studies have shown that white blood cell (WBC) count, mean platelet volume (MPV), C‑reactive protein(CRP), anderythrocyte sedimentation rate(ESR) can play an important role in the diagnostic prediction of appendicitis. Therefore, the aim of this study was to evaluate the diagnostic value of WBC count, polymorphonuclear leukocytes (PMNs) percentage, MPV, CRP, and ESR for the diagnosis of AA. In this study, 100 medical records were reviewed for children referred to the hospital complaining of abdominal pain and who underwent operation with aprovisional diagnosis of acute appendicitis based on clinical and laboratory findings. Patients were divided into two groups according to the pathology gold standard method: AA and the other group with acute abdominal pain without appendicitis (AAP). The diagnostic accuracy of WBC, PMNs%, MPV, ESR, and CRP were compared for patients with AA and AAP. A total of 100patients (50 with AA and 50 with AAP) were identified. The sensitivity and specificity of WBC and PMNs% were 78 and 66%, and 76 and 54%, respectively; ESR was 80 and 48%, respectively; and CRP was 82 and 62% (30-89%), respectively. Alow specificity (8%) and 70% sensitivity was calculated using the cutoff point of 8.1 fl for MPV. Our data suggest that children with AA often present with significantly higher WBC count, ESR level, CRP level, PMNs%, and lower MPV level. The results of the study showed that WBC, CRP, and ESR, along with other diagnostic methods, can be useful in diagnosing AA in children. MPV is not effective in the diagnosis of AA due to its specificity; however, asignificantly lower level was found in children with AA.

Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis: a systematic review.

Despite the radiological and analytical advances of the last decades, there is still a significant rate of diagnostic error in pediatric acute appendicitis. In recent years, multiple biomarkers have emerged as potential diagnostic tools. This study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute appendicitis. We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers. The research in the medical bibliography databases resulted in 68 articles. We removed 26 duplicates. Among the remaining 42 articles, we excluded 33 following the inclusion and exclusion criteria. Of the final 9 studies included in this review, 8 provided measured serum interleukin-6 values, and all of them reported significant differences between groups, but inconsistent results regarding sensitivity and specificity. The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is limited. The sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated appendicitis. There seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute appendicitis. The increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated appendicitis. We consider that this may be an avenue of research to explore in the future.

Value of high frequency ultrasonography in differential diagnosis of mesenteric lymphadenitis and acute appendicitis in children.

article: Value of high frequency ultrasonography in differential diagnosis of mesenteric lymphadenitis and acute appendicitis in children - Minerva Pediatrics 2022 June;74(3):389-91 - Minerva Medica - Journals

Red Blood Cell Distribution Width: Diagnostic Value in Pediatric Acute Appendicitis

Introduction and Objectives: Acute appendicitis (AA) is one of the most common causes of urgent surgery in children and is still associated with diagnostic difficulties. As the red blood width (RDW) and mean platelet volume (MVP) may be related to inflammatory processes, this study aims to evaluate the diagnostic value of RDW in AA in pediatric population. Methods: A retrospective and observational study was conducted. Data was collected from medical records of all patients with clinical suspicion of AA who underwent appendectomy at a secundary hospital during a period of 36 months. Preoperative analytical values were analyzed and compared with a control group. Results: Medical records of 305 patients with a mean age of 12.1 years were analyzed. Children with simple or perforated appendicitis had significantly higher RDW than those with a normal appendix. Compared with the controls mean RDW was significantly higher in the acute appendicitis group (14.16 ± 1.2% vs.13.09 ± 0.9%, p <0.05). No statistically significant differences were found in the analytical parameter VPM in the diagnosis of AA. Conclusion: In this study, children with an histologically diagnosed acute appendicitis have higher RDW than children without appendicitis. Being a parameter included in the blood count and without additional costs, it may represent a valuable aid in the diagnosis of acute appendicitis in children. Further research is needed due to the limited number of studies on this topic in childhood.

Complicated acute appendicitis in children: the importance of stewarding antibiotic prescriptions.

The aim was to assess the success of a three-drug regimen, consisting of cefazoline, metronidazole and gentamicine, for the antimicrobial treatment of complicated appendicitis and to investigate predictors of failure. This retrospective study included patients who had undergone appendectomy for complicated appendicitis from 2013 to 2018. The shift to second-line antibiotics was considered a failure. The choice was based upon clinical deterioration. Patients were grouped into 2 groups: localized complicated appendicitis (LCA) and extensively complicated appendicitis (ECA) for the study purpose. Univariate and multivariate analysis were performed to identify predictors of failure. Ninety patients (65.2%) with LCA and 48 patients (35%) with ECA were included. Three-drug regimen failed in 50 patients (36%) with a higher rate in the ECA group (50%, p=0.017). In a multivariate analysis, this failure was found to be associated with ECA (adjusted OR 3.00 [1.2-7.4], p=0.041). Children with ECA experienced a longer hospital stay (median length 8 days, p < 0.001) and antimicrobial therapy (median length 8 days, p < 0.001). However, no difference in the rate of surgical site infections was found (p=0.514). The institutional antibiotic stewardship program highlighted a high failure rate for the old threedrug regimen. A new protocol should be recommended, especially for the patients affected by ECA.

Clinical Value of Abdominal Ultrasonography in the Diagnosis of Acute Abdomen in Children.

In order to study the practical application value of abdominal ultrasonography in the diagnosis and treatment of acute abdomen in children, this study uses the method of collecting clinical actual cases and scientific analysis to estimate the clinical diagnostic value of high-frequency ultrasound and low-frequency ultrasound. In order to further clarify its curative effect and treatment advantages, a retrospective analysis of medical records was conducted, and 95 children with acute abdominal pain and suspected appendicitis who were admitted to a hospital from September 2021 to November 2021 were reviewed. ATIL HD15000 color Doppler ultrasound was used for diagnosis. The results are as follows: the sensitivity, specificity, positive predictive value, and negative predictive value of low-frequency probe in the diagnosis of intussusception in children were 83.61%, 73.33%, 92.73%, and 52.38%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 80.00%, 81.97%, 52.17%, and 94.34%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of high-frequency probe in the diagnosis of intussusception in children were 93.44%, 80.00%, 95.00%, and 75.00%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 93.33%, 95.08%, 82.35%, and 98.31%, respectively. Among the children with appendicitis confirmed by operation and pathology, 69 cases were detected by high-frequency ultrasound and 4 cases were missed (including 3 cases of acute simple appendicitis and 1 case of perforated appendicitis). The false negative was 4%, there was no false positive, and the sensitivity, specificity and accuracy were 95%, 100%, and 96%. In the same cases, 28 cases were detected by low-frequency ultrasound, 45 cases were missed, the false negative was 61%, and there was no false positive. The sensitivity, specificity, and accuracy were 39%, 100%, and 53%. The sensitivity, accuracy, and false negative of high-frequency ultrasound in the diagnosis of acute appendicitis were significantly higher than that of low-frequency ultrasound. This study shows that ultrasound has high accuracy, sensitivity, and specificity in the diagnosis of acute appendicitis. Low-frequency ultrasound can show the whole picture of the disease and the situation in the abdominal cavity, which can better guide the clinical treatment. Color Doppler hemodynamics is a useful supplement to two-dimensional ultrasound, and ultrasound also plays a positive role in the differential diagnosis of acute appendicitis in children.

Postoperative recovery assessment after appendectomy in children - laparoscopic versus open technique

Introduction/Objective. Surgery is a ?gold standard? in treating the acute appendicitis in pediatric patients. The aim of the study was to determine the effect of open and laparoscopic appendectomy on postoperative recovery, return to everyday activities, and the quality of life in patients operated on for acute appendicitis. Methods. This prospective study was performed at the Institute for Children and Youth Healthcare of Vojvodina, over a period of 10 months. This study was approved by the Ethics Committee of the Institute. All patients treated for acute appendicitis by surgery were divided into two basic groups ? open or laparoscopic appendectomy ? and into three subgroups, depending on the degree of appendicitis. We analyzed the length of surgery, oral intake, establishing peristalsis, hospital stay, return to everyday activities, and the quality of life after surgery. Results. Laparoscopic technique was performed in 60 patients (48%), and the open method in 65 patients (52%). In 66.7% of laparoscopically treated patients, peristalsis occurred earlier (p < 0.001), length of hospital stay was shorter (5.95 ? 1.21 days) (Z = -3.054; p = 0.002), the total score of daily activities showed a statistically significantly better score (Z = -7.667; p = 0.000), and they achieved a high level of quality of life significantly earlier (t = 2.773; p = 0.007). Conclusion. The advantages of minimally invasive surgery in the treatment of acute appendicitis in children are reflected in the faster re-establishment of everyday functioning, faster recovery, and a good quality of life.

Значення комплексної оцінки інтегрального показника ендогенної інтоксикації організму та ультразвукової візуалізації апендиксу в діагностиці гострого апендициту у дитячому віці

Traditionally, in the diagnosis of acute appendicitis and endogenous intoxication that accompanies its course, hemogram indicators and a wide range of proposed hematological indices are widely used. However, as practice shows, the isolated study of the hemogram, even with the involvement of its integral indices, especially in the early stages of pathology, is not enough for its timely diagnosis, and even more so the differential diagnosis. An important additional method of diagnosing acute appendicitis is ultrasound. Purpose – on the basis of specific clinical observation in the dynamics of the abdominal pain syndrome to determine the complex diagnostic significance of the integrated indicator of endotoxicosis of the body and ultrasound. Materials and methods. As an integral indicator of endogenous intoxication, the integrated indicator proposed by the authors was chosen, which was calculated based on the indicators of the general analysis of peripheral blood: the number of leukocytes, ESR and leukogram indicators according to the formula. To facilitate the calculation of the value of the total index of endogenous intoxication, a calculator based on a program for working with Excel spreadsheets was developed, in the environment of which the proposed index formula was integrated. Ultrasound examination was performed with Doppler scanning on ultrasound machines «SAMSUNG H60» (manufactured in South Korea) and «SAMSUNG» LS22EMU1HS (Seoul. Korea, 2016). Results. Simultaneous comparison of the dynamics of local changes in the clinical picture, hemogram, the magnitude of endogenous intoxication and visual findings in ultrasound of the abdomen allows to avoid unwarranted surgery in patients with abdominal pain. Conclusions. Properly collected anamnesis, assessment of physical and clinical and laboratory parameters and data of laboratory methods of examination, the involvement of the necessary narrow specialists allows to avoid mistakes in the diagnosis of acute appendicitis in children. It is expedient and justified in the diagnostic assessment of the clinical picture in case of suspicion of acute appendicitis to compare the indicators of the integrated index of endogenous intoxication, namely the total index of endogenous intoxication with ultrasound visualization of the appendix in the dynamics of the pathological process. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: intoxication index, ultrasound, appendicitis.

Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study.

BackgroundNonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post–COVID-19 world, change surgeons’ perceptions of NOT.ObjectiveThe aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides.MethodsA survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19–imposed level of NOT after the effect of the pandemic diminishes.ResultsA total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19–level of NOT practice after the pandemic.ConclusionsIncreased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post–COVID-19 world.

Impact of the COVID-19 pandemic on acute appendicitis in children

Background and objectivesSince the COVID-19 pandemic confinement was established in Spain on March 9, 2020, the number of visits to the pediatric Emergency Department (ED) has decreased dramatically, probably due to the fear of parents becoming infected in the hospital environment. The aim of this work was to analyze the medium-term consequences during the first 9 months after the onset of the COVID-19 pandemic in children with acute appendicitis (AA). Material and methodsA retrospective study was performed on children operated on for AA in our institution between 2017 and 2020, who were distributed in two groups according to the date of surgery: COVID-19 group (after March 9, 2020) and control group (before March 9, 2020). Demographic variables, associated symptoms, time from symptoms onset, hospital stay, rate of complicated AA and postoperative complications were analyzed. ResultsA total of 1274 patients were included (288 COVID group; 986 control group), without demographic differences. Time from symptom onset was significantly longer in COVID-19 group (34.5 vs. 24.2h; p=0.021), although no differences in associated symptoms were observed between both groups. COVID-19 group presented a higher rate of complicated AA (20.1% vs. 14%; OR: 1.55; CI 95% [1.10–2.18]; p=0.008), a longer hospital stay (3.5 vs. 2.8 days; p=0.042) as well as a higher rate of postoperative complications (21.5% vs. 15.7%; OR: 1.47; CI 95% [(1.06–2.04)]; p=0.008). ConclusionIn our experience there was a negative medium-term effects of the COVID-19 pandemic on children with acute appendicitis: delayed ED visits, increased rate of complicated AA, increased hospital stay and increased postoperative complications.

Acute appendicitis in children: Reexamining indications for conservative treatment – A large prospective analysis

IntroductionConservative antibiotic treatment (CAT) for uncomplicated acute appendicitis (AUA) in children has been proven safe and efficacious. However, as data accumulate, high rates of recurrent appendicitis and subsequent appendectomy have been reported. This prospective longitudinal study evaluated risk-factors for recurrent AUA after CAT in a large cohort, with long-term follow-up. Materials and methodsChildren ages 5 to 16 years admitted to the Department of Pediatric Surgery from 2014 through 2018, diagnosed with AUA were eligible for CAT. We recorded their age, appendix outer diameter, white blood cell counts, C-reactive protein and other related signs and symptoms associated with AUA. Clinical and ultrasonographic follow-up was carried out until follow-up data collection ceased according to the study design (2014–2019). ResultsThe cohort included 646 children who were initially treated successfully with CAT. Among them, 180 (28%) were readmitted for recurrent acute appendicitis during the follow-up period and 138 (21%) eventually had appendectomy. Overall success of 79% for CAT was recorded in this cohort. A multivariable model including; age, sex, appendiceal diameter, WBC and CRP, found the factors of older age, larger outer appendiceal diameter and high WBC counts significantly related to appendectomy during the follow-up period. We offer a decision tree model to predict appendectomy probabilities for patients based on their prognostic measurements. ConclusionCAT in AUA in children should consider older age, larger outer appendiceal diameter and high WBC counts as risk-factors for recurrent AUA and subsequent appendectomy. The proposed decision tree model may help both clinicians and parents before CAT is chosen. Level of evidenceLevel 2

Evaluating the value of different sonographic findings in diagnosis of acute appendicitis in children.

Introduction:Appendicitis is one of the most common paediatric surgical emergencies occurring in about 7% of healthy children. To make a definitive diagnosis preferably avoiding unnecessary X-ray radiation exposure, ultrasound is the ideal modality. The aim of this study is to evaluate the diagnostic value of sonographic findings in children with acute appendicitis and comparing them with surgical findings to demonstrate the safety, simplicity and accuracy of this procedure in emergency departments as the first diagnostic procedure.Materials and Methods:One hundred and eight children aged 1–15 years suspected of acute appendicitis in our tertiary hospital emergency department enrolled the study. Patients presenting as acute abdomen suspected as having acute appendicitis underwent abdominal ultrasonography (US) at first. Sonographic findings were compared to surgical and pathologic results, and sensitivity and specificity of each sonographic parameter in paediatric appendicitis were evaluated.Results:The analysis of sonographic results showed that 67.6% of patients had acute appendicitis, 13.9% had perforated appendicitis and 18.5% had normal appendix. On the other hand, there were acute appendicitis in 63.9% of patients, perforated appendicitis in 12% and normal appendix in 8.3% in surgical reports. Sensitivity of uncompressible appendicitis, appendicitis, maximal outer diameter (MOD) above 6 mm, maximal mural thickness (MMT) above 3 mm, round appendix was 98.68%, 28.04%, 94.74%, 61.84% and 68.42%, respectively. Specificity of incompressible appendicitis, appendicitis, MOD above 6 mm, MMT above 3 mm, round appendix was 64.71%, 96.15%, 64.71%, 82.35% and 94.12%, respectively. Overall sensitivity and specificity of US in appendicitis were 97.56% and 69.23%, respectively.Conclusion:According to the findings of this study, sensitivity of US in diagnosing appendicitis is higher than other studies, but its specificity was lower. Ultrasonographic accuracy and efficacy to diagnose acute appendicitis in children are high enough to allow clinicians to do it as an imaging modality of first choice, and also, in problematic cases to assist correct clinical diagnosis avoiding unnecessary X-ray exposure, decreasing negative appendectomies, decreasing perforation rate and lowering the cost of patients. Furthermore, negative US do not justify immediate computed tomography because clinical re-evaluation and a second US can help greatly the clinicians in the correct diagnosis.