Surgical Outpatient Clinic Research Articles

Erectile Dysfunction among Male Infertile Men Attending the Surgical Outpatient Clinic in a Tertiary Hospital in Nigeria over a 7-Year Period—A Single Surgeon’s Experience

Background: There is misconception about male Infertility and erectile dysfunction (ED) with poor health seeking behaviour in our clime. This study aims at finding the association between erectile dysfunction and male infertility in Ibadan. Methods: This was a retrospective comparative study that analysed records of all men with male infertility between May 2016 and April 2023 at the surgical outpatient in a tertiary hospital in Ibadan. Data included demography, social habit, the severity and prevalence of ED, and type of infertility. The data were analysed with a Statistical Package for the Social Sciences (SPSS) version 25. Logistic regression analysed the association between male infertility and erectile dysfunction. A p-value of < 0.05 was regarded as statistically significant. Results: A total of 109 cases of male infertility of which 65 (59.6%) had ED. The overall mean age for primary and secondary infertility were 37.62 ± 6.95years and 40.62 ± 8.322 years respectively (t=2.892; p< 0.004). The mean age for absence and presence of ED were 39.08 ± 6.61years and 39.56 ± 7.94years respectively (t=0.340; p= 0.734). There is association between alcohol consumption and ED (χ2=6.969; p< 0.008). Similarly, statistically significant association between the ED and the type of infertility as mild, mild-moderate, and moderate ED were commoner among men with primary infertility and all men with severe ED had secondary infertility (χ2=12.283; p<0.015). Conclusions: The prevalence of erectile dysfunction among male infertility was 59.6% with statistically significant association between the severity of ED and male infertility. Public awareness is advocated.

Comparison of serum 25-hydroxy vitamin D amongst black African prostate cancer patients with non-aggressive versus aggressive disease using the Gleason score

Background: Black men of African descent have higher risk for developing prostate cancer and present at a younger age with advanced disease and a poorer prognosis. Limited number of studies directly linking serum vitamin D with either prostate cancer prognosis or measures of prostate cancer aggressiveness have been done. The objective of this study is to compare serum 25 hydroxy vitamin D levels in patients with non-aggressive and aggressive prostate cancer using the Gleason score in black Africans in Jos. Methods: A cross sectional study conducted among fifty patients who presented to the urological surgical out-patient clinic of the Jos University Teaching Hospital who had clinical diagnosis of prostate cancer and were scheduled for prostate biopsy. Blood samples for serum 25-hydroxy vitamin D assay was analysed using the enzyme linked immunosorbent assay (ELISA) technique, patients with histologically confirmed prostate cancer were analysed. Data was collected in a proforma, statistical analysis done using statistical package for the social sciences (SPSS)(R) version 23 and t-test was used for comparison with a p value <0.05 considered significant. Results: Fifty patients were studied whose age ranged from 50-89 years. The mean level of serum 25-hydroxy vitamin D was 37.90 ng/ml±17.92. The mean serum 25-hydroxy vitamin D of patients with non-aggressive disease (GS≤6) and aggressive disease (GS≥7) was 48.44±17.09 and 34.57±17.08 respectively with a p value of 0.018. Conclusions: This study showed that black African prostate cancer patients with high grade tumors (Gleason score ≥7) had significantly lower 25-hydroxy vitamin D levels compared to those with low grade tumors (Gleason score <7).

MAXILLOFACIAL DIPROSOPUS: AN EXTREMELY RARE CONGENITAL ANOMALY AND ITS SURGICAL MANAGEMENT

Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications. Diprosopus characterizes congenital craniofacial duplication, an exclusive maxillofacial involvement that has only been documented twice. A seven-month-old girl attended the surgical outpatient clinic due to a congenital mandibular alteration and cervical tumor mass. Extraoral physical examination revealed a 3cm right sessile appendiceal nodule with a central ostium, which secreted a hyaline fluid in the mandibular cutaneous region and was mobile during breastfeeding. Moreover, an ipsilateral level II asymptomatic cervical enlargement was observed. A computed tomography showed the duplication of the condyle, ramus, and mandibular body on the right side, which had a mandibular canal and teeth germs emerging toward the skin nodule, as well as a 4.1cm submandibular/cervical well-defined cystic hypodense image. Clinicoradiographic aspects were conclusive for mandibular and mouth duplication. Surgical excision of the accessory mandible, cutaneous nodule/accessory mouth, and cervical cyst were performed and sent for pathological examination. The patient is undergoing strict follow-up, without post-surgical complications.

Factors affecting timeliness in management of head and neck cancer.

Timeliness in the management of patients with head and neck cancer (HNC) can be affected by both patient and non-patient related factors. This study aims to investigate the factors associated with the timeliness of managing HNC. A retrospective review was conducted on Western Health medical records including all new patients presenting to the Western Health HNC surgical outpatient clinic in the five-year period from first January 2017 to 31st December 2021 with the diagnosis of a HNC. Both patient and non-patient related factors were compared with the duration between a patient's referral to a HNC service and the commencement of their treatment. Two hundred and twenty-eight patients were included in this study. The median duration from referral to the commencement of treatment was 48 days. Lack of radiological or pathological investigations prior to referral to a HNC service as well as early staging were found to significantly impact timeliness in management. Socioeconomic factors such as non-English speaking backgrounds, distance from the hospital and lack of social supports were not found to negatively impact timeliness of management. The management of patients with HNC require careful consideration of all patient and non-patient related factors which may affect timeliness in management, particularly investigations performed prior to their referral to a HNC service.

The Hubungan word of mouth, kualitas pelayanan, kepuasan dan loyalitas pelanggan klinik rawat jalan bedah onkologi di Rumah Sakit Khusus Bedah X

Background: Customer loyalty is absolutely necessary because without customer loyalty the hospital cannot develop, it can even experience a decline in business that threatens the existence of the hospital. But to achieve customer loyalty many influencing factors such as service quality, word of mouth and customer satisfaction.Objective: Therefore it is necessary to know which factors significantly affect customer loyalty, so that the hospital can develop effective and efficient program and strategies.Methods: This study is an explanatory research by examining relationship of the variables. Respondents in this study were 195 people that were customer of the Surgical Oncology Outpatient Clinic of X Surgical Specialty Hospital. Data processing using the SEM PLS Method with Smart PLS application.Results: The results show that service quality have a positive and significant direct effect to customer satisfaction and loyalty. Word of mouth also shows positive and significant direct effect to customer satisfaction and loyalty. But this study failed to prove a significant direct effect of customer satisfaction to customer loyalty.Conclusion: We can significantly increase customer satisfaction and customer loyalty by increasing service quality and improve word of mouth activity. However customer satisfaction is not a significant factor for customer loyalty

The utility of chemical shift imaging and related Dixon images in evaluation of bone marrow edema-like changes in diabetic foot

BackgroundMagnetic resonance imaging (MRI) is the best diagnostic tool for suspected diabetic foot osteomyelitis (DFO); adding T1-based Dixon to MR technique can identify the bone marrow edema-like signal observed in neuropathic joints and differentiate it from that observed in DFO. The aim of this study was to assess the diagnostic efficacy of chemical shift imaging (T1 in-phase and out-of-phase) and related Dixon sequence in differentiation between infectious edema-like signal found in osteomyelitis and bland edema signals observed in osteomyelitis mimickers (as neuropathic arthropathy). The study was conducted on 50 patients who were referred by surgical outpatient clinics between January 2020 and January 2022; they underwent MRI of the foot including T1-Dixon sequence.ResultsThere were variable bone and joint affection, and the most common location of bony affection in the study was the hind-foot. Forty-four out of fifty patients had bone marrow edema-like signals. Thirty-seven patients (74%) were diagnosed with osteomyelitis, whereas seven (14%) patients were diagnosed with non-infective/bland bone marrow edema signals which were related to Charcot arthropathy and/or nearby infection. Both visual and quantitative assessments of chemical shift imaging showed high sensitivity and specificity in diagnosis of DFO. The optimal cut-off point of signal intensity ratio for diagnosis of DFO was 1.005 with high sensitivity and specificity.ConclusionsChemical shift imaging and related Dixon sequence were reliable methods in diabetic foot evaluation; they could help differentiate infectious edema-like changes of osteomyelitis from and bland edema of osteomyelitis mimickers with high sensitivity and specificity especially on using quantitative analysis of their signal abnormality.

Evaluation of the outcome of “telephone clinic” in the follow-up of surgical patients: innovative use of technology for the convenience and improvement of service for patients

Background: Government-funded health systems are the hallmarks of welfare states. They always suffer from over-burden and are underfunded. This results in painful waiting lists and long clinics. In order to reduce the suffering of patients attending surgical outpatient clinics, the innovative initiative of telephone clinics was taken five years ago. This study was conducted to assess success and find areas or groups requiring attention.

Castleman Disease and Literature Review from Mankweng Hospital, Limpopo, South Africa

Castleman disease is a lymphoproliferative disorder and is easily confused with lymphoma or other lymphadenopathy. Castleman’s disease is divided into unicentric Castleman disease, which involved a single enlarged lymph node or region of lymph nodes, and multicentric Castleman disease, which involved multiple lymph node stations. In this paper we highlight the presentation of Castleman’s disease on a female patient to share our experience with literature review. Case Presentation: A 29 years old female patient was referred to our surgical outpatient clinic from the peripheral hospital with right & left painless neck cervical mass slowly growing which started 3 years ago along with a right breast lump and patient was RVD non-reactive. On physical examination she was severely wasted. She had a 4cm by 3cm mass of the right supraclavicular region & another mass of 3cm x 1 cm mass on the left supraclavicular area. Her abdominal examination revealed hepatomegaly which is extended 8 cm below the subcostal margin. Histology report of cervical mass concluded Reactive lymph nodes with features of hyaline vascular Castleman disease and Breast mass revealed fibroadenoma. Immunohistochemistry of cervical node biopsy for HHV8 is negative. Blood result of inflammatory markers: C - reactive protein was 459 mg/L. Conclusions: Owing to the rarity of this condition, Castleman Disease Collaborative Network (CDCN) guideline is important for assessment & treatment plan.

Normal values of respiratory oscillometry in South African children and adolescents.

Noninvasive measurement of respiratory impedance by oscillometry can be used in young children aged from 3 years and those unable to perform forced respiratory manoeuvres. It can discriminate between healthy children and those with respiratory disease. However, its clinical application is limited by the lack of reference data for African paediatric populations. The aim of the present study was to develop reference equations for oscillometry outcomes in South African children and adolescents. Healthy subjects, enrolled in the Drakenstein Child Health Study, HIV-uninfected adolescents in the Cape Town Adolescent Antiretroviral Cohort and healthy children attending surgical outpatient clinics at Red Cross War Memorial Children's Hospital were measured with conventional spectral (6-32 Hz) and intra-breath (10 Hz) oscillometry. Stepwise linear regression was used to assess the relationship between respiratory variables and anthropometric predictors (height, sex, ancestry) to generate reference equations. A total of 692 subjects, 48.4% female, median age of 5.2 years (range: 3-17 years) were included. The median (interquartile range (IQR)) for weight for age z-score and height for age z-score was -0.42 (-1.11-0.35) and -0.65 (-1.43-0.35), respectively. Stepwise regression demonstrated that all the variables were significantly dependent on height only. Comparison to previous reference data indicated slightly higher resistance and lower compliance values in the smallest children. We established the first respiratory oscillometry reference equations for African children and adolescents, which will facilitate use in early identification and management of respiratory disease. Our results suggest differences in oscillometry measures by ancestry but also highlight the lack of standardisation in methodology.

Influence of health institution related factors on health seeking behaviors among men suffering from lower urinary tract symptoms attending surgical outpatient clinic at a county referral hospital Meru Kenya

Background: Currently there is an increase in cases of men presenting with lower urinary tract symptoms (LUTS) especially in low resource countries. The purpose of this study was to establish the influence of health institution related factors on health seeking behaviors among men suffering from LUTS attending surgical outpatient clinic at Meru county referral hospital, Kenya. Methods: Descriptive cross-sectional study design was used. Population involved 120 men suffering from LUTS, 2 physicians and 2 nurses. The study tools used were questionnaires, key informant interview guides and focus group discussion guides. The quantitative data was analyzed using chi-square test and binary logistic regression. Hypothesis testing was done at an alpha level of significance of 0.05 such that any p-values below the alpha were deemed significant. Qualitative data was analyzed thematically Results: Health institutional related factors which included adequate personnel 2.57 [95% CI=1.09-6.06, p=0.032], adequate drugs 3.14 [95% CI=1.36-7.23, p=0.007], treated well by the health care workers 2.95 [95% CI=1.18-7.36, p=0.021], short duration time taken to be served in the hospital 2.40 [95% CI=1.12-5.16, p=0.025] and distance to the health facility 2.21 [95% CI=1.01-4.84, p=0.047], significant parameters associated with health seeking behaviors Conclusions: There was significance influence of health institution related factors on health seeking behaviors among men suffering from LUTS.

A comparative study between Wagner’s classification and new wound based diabetic foot ulcer severity score

Background: Diabetes is considered to be one of the most common health problems all over the world in 21st century. In fact, it has been coined the ‘Black death of the 21st century due to its stark similarities with the 14th century plague in terms of rapid increase in its prevalence, morbidity and mortality. According to WHO, the number of diabetic patients in 2000 reached to 171 million and was predicted to increase to 380 million by 2020. The Indian diabetic population is expected to increase to 57 million by the year 2025. Diabetic foot ulcers are one of the most distressing complications of diabetes affecting around 15% of people with diabetes. The annual incidence of diabetic foot ulcers is around 3% and the reported incidence in U.S and U.K studies ranges as high as 10%. It has been reported that 85% of the lower limb amputations in diabetic patients are preceded by foot ulceration. These systems are variously based on the site of ulcer, depth, and presence or absence of neuropathy, infection and peripheral arterial disease and have been used to compare the outcomes. Diabetic ulcer severity score (DUSS) is one of the latest wound-based systems of classification. However, there is paucity of enough data to validate whether DUSS system is better as compared to other established and commonly used scoring system like Wagner’s classification. Hence, it was decided to validate DUSS scoring system with Wagner’s classification by comparing both keeping in view outcome of the disease. Methods: Patients admitted under various surgical units from January 2022-January 2023, at Mamata medical college and hospital, Khammam. Total of 40 diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the hospital (Mamata general hospital) were recruited into the study based on the inclusion and exclusion criteria mentioned below. Results: DUSS score and Wagner’s score were found to be almost equal in evaluating the scores for treatment as p value was found to be statistically significant (p=0.001) and by KAPPA stats there was an absolute agreement (score 1) between DUSS and Wagner’s scoring system. Conclusions: The new severity scoring system (DUSS) is equal to gold standard Wagner’s scoring system for predictive analysis which also provides an early idea regarding hospital admission, local surgery and health care costs. Since this scoring system 72 can be easily applied in daily clinical practice, it may be suitable in estimating putative healthcare costs.

Exploring the educational value of the general surgical outpatient clinic: a systematic review.

Optimising opportunities for exposure and learning in the clinical environment is a priority for surgical education. The surgical outpatient clinic provides a setting for engaging with the patient journey while gaining essential surgical knowledge and skills. This systematic review seeks to determine the role of the outpatient clinic in current surgical education for multiple levels of learners and identify strategies to improve educational utility. A systematic search strategy was conducted across Medline (OVID), Embase, PubMed, and Web of Science databases according to PRISMA guidelines. A comprehensive grey literature search for evaluation of international postgraduate surgical curricula was also performed. Publications were included if they discussed or utilised the general surgical outpatient clinic in an educational context. Nine publications were included in this review. Educational interventions in a surgical outpatient clinic setting were discussed in three publications and two publications presented observational data relating to educational opportunities in the surgical outpatient clinic. Four postgraduate surgical curricula outlined the current approaches to surgical education in the outpatient clinic setting. Assessment of included studies by Kirkpatrick level of evidence highlighted that included studies did not investigate high-order educational outcomes. Thematic analysis of curricula was utilised to build a common set of learning outcomes. Educational interventions were found to improve learning outcomes, particularly those that facilitated active student participation. Postgraduate surgical curricula utilise the surgical outpatient clinic and recognise its importance in surgical training through the implementation of outpatient-based learning objectives which serve as fundamental components of training. Common learning objectives can be used to direct further research into the efficacy of this educational context. The online version contains supplementary material available at 10.1007/s44186-023-00106-8.

A Practical and Applicable New Index as an Indicator of Inflammation in the Diagnosis of Erectile Dysfunction: C-reactive Protein-to-Albumin Ratio

Current evidence suggests that the significant underlying pathophysiological mechanism in erectile dysfunction (ED) is endothelial dysfunction. It is clinically essential to monitor ED because inflammatory processes lead to dysfunctional endothelium and the progression of atherosclerosis. The current retrospective analysis assessed the registers of 90 patients with ED complaints (ED group) and 78 healthy people without ED complaints (control group) who were being managed at the urology units of the surgical outpatient clinic. The international index of erectile function-5 (IIEF-5) evaluated the ED. C-reactive protein (CRP)/albumin ratio (CAR) value was determined by manually dividing serum CRP value by the albumin value in patients whose CRP value was between 0 and 5 mg/l. The average CAR was 0.45 ± 0.37 (ED group) versus 0.22 ± 0.1 in the control group (p=0.0001). IIEF-5 results were negatively correlated with CAR values (r=−0.299; p=0.0001). The strongest cut-off of CAR for predicting ED was 0.025, with 81.8% sensitivity and 75% specificity (p=0.0001). The ED group showed higher levels of CAR and CRP than the control group. CAR can be used as a practical, easy-to-calculate, and cost-effective index in diagnosing ED patients.

Determinants of Quality of Life in Women living with Breast Cancer in Southwest Nigeria

Background: The quality of life (QOL) among women with breast cancer is hampered in areas of social, emotional, and sexual functioning and this could persist even years after treatment. It is an important parameter for monitoring disease progression at the early stage. Hence, this study aimed to determine the factors associated with the overall quality of life among subjects living with breast cancer.
 Methods: The study was a comparative cross-sectional design conducted among women with breast cancer attending the General Surgical Outpatient clinic of LAUTECH Teaching Hospital Ogbomoso and a comparison group of age-matched control. The instrument used include the World Health Organization Quality of Life-BREF and socio-demographic and clinical variable questionnaire in 240 interviewer-administered questionnaires. Data were analyzed using SPSS version 21. A P-value of less than 0.05 was taken as statistically significant. The predictors of overall QOL were analyzed using a binary logistic regression.
 Results: All QOL domain scores were significantly higher among controls than in subjects with breast cancer. ρ-value = 0.001. Level of education and duration of diagnosis had a statistically significant association with the overall quality of life, P-value< 0.05. Respondents who attained a tertiary level of education were 0.040 times less likely to have a poor quality of life compared to respondents that were not educated (P-value= 0.038) and the odds of having a poor overall quality of life decreased with duration since diagnosis P-value= 0.049.
 Conclusion: Our study shows that women with breast cancer experience a lower QOL, especially in the physical, psychological and social domains than women without the disease. Also, the level of education, employment and marital status, and duration since diagnosis were major factors influencing QOL. Assessment of QOL is an important metric that should be incorporated into the breast cancer treatment program.

Awareness of chronic hepatitis C in the Western Black Sea Region.

Chronic hepatitis C (CHC) can be cured with oral antivirals. Awareness of CHC is a substantial barrier to the World Health Organization's goal of eradicating HCV by 2030. This study aimed at evaluating CHC awareness among different departments in a Western Black Sea Region University Hospital. Anti-HCV and HCV RNA test results of all patients admitted to our center for whatever reason and who underwent anti-HCV screening between January 2017 and January 2022 were analyzed. CHC awareness has been defined as the presence of HCV RNA testing for anti-HCV positives. Of the 63,963 patients who underwent anti-HCV testing, anti-HCV positivity was observed in 2%. HCV RNA was tested in 647 (48.8%) patients who had tested positive for anti-HCV. The HCV RNA was positive in 212 (32.7%) patients tested. Only 66 (29.7%) of those with positive HCV RNA test results had received antiviral therapy. The distribution of HCV RNA testing rates for patients with positive anti-HCV by different departments were as follows: 33% (n=78/232) in medical inpatient clinics, 78% (n=539/685) in medical outpatient clinics, 7% (n=16/223) in surgical inpatient clinics, 7% (n=14/183) in surgical outpatient clinics, and 0% in the emergency department. The prevalence of anti-HCV positivity in our region was 2%. Less than half of the patients tested for anti-HCV had HCV RNA testing, and less than a third of the HCV RNA-positive patients received antiviral therapy. To meet the WHO's HCV eradication target by 2030, it is necessary to increase physicians' awareness of CHC.

244 (PB-068) Poster - Usability test of BREAST-Q questionnaires during pre-implementation of Patient-Reported Outcomes Measures in a Plastic- and Breast Surgical Outpatient Clinic

Background: Significant evidence support the benefits of implementing patient-reported outcome measures (PROMs) in routine clinical practice. Collecting PROMs electronically requires adequate assessment of the user interfaces to ensure that the electronic patient-reported outcomes measures (ePROMs) are fit for the purpose and user-friendly. The aim of this study was to investigate the usability and technical feasibility of BREAST-Q as ePROMs.

164 (PB-077) Poster - Exploring timely perspectives of embodiment in women diagnosed with breast cancer undergoing oncoplastic breast surgery: A qualitative study from a plastic- and breast surgical outpatient clinic

Background: Women diagnosed with breast cancer in Western countries are increasingly offered oncoplastic breast surgery as part of breast cancer treatment. As the number of breast cancer survivors grows due to development in surgical and medical treatment, long-term outcomes and the experiences of individuals with breast cancer, such as quality of life related to satisfaction and body image, have become increasingly important components of breast cancer treatment and rehabilitation. Previous research indicates that women who undergo breast reconstruction after breast cancer treatment report the highest long-term satisfaction with their breasts.

Person-centred support programme (RESPECT intervention) for women with breast cancer treated with endocrine therapy: a feasibility study

ObjectiveThe peRson-cEntred Support Programme EndoCrine Therapy intervention is a complex intervention encompassing a person-centred support programme for patients with breast cancer being treated with endocrine therapy (ET). The aim of...

Resident Perspectives on the Value of Rural General Surgery Rotations: It's Not Just About the Cases.

Understand the scope of cases that residents participate in during rural general surgery rotations and the value residents and program directors find in such rotations. In turn, our goal is to add to the ongoing conversation the value exposure to rural surgery brings to surgery training. Qualitative study analyzed reviews of residents' self-reported case lists and field notes from exit interviews with the site director. Trainees participated in an average of 105 cases during the rotation, including basic and advanced endoscopy along with exposure to a wide array of surgical cases. Residents had exposure to the rural facility and its staff and participated in a busy outpatient surgical clinic, the hospital, and community activities. We received overwhelmingly positive qualitative feedback from residents regarding how this rural rotation advanced their skills, helped prepare them for life after residency, and for some confirmed their plans to practice in a rural location. With the decline in the number of rural general surgeons and projected continuance of this trend, it is important to understand how trainees view their residency experiences and how those experiences may be shaping their outlook on career choices. Our single-site, qualitative study showed that a rural general surgery rotation during residency has broad importance and value in general surgery resident training. Having a rural rotation also allowed residents to gain understanding of a rural lifestyle, workflow, and the social fabric including the rural surgeons' connections with their communities.

Diagnosis and Management of Chronic Appendicitis in Children: A Case Report

Background: Abdominal pain was one of the most complaints in children. Chronic appendicitis was the common cause of recurrent abdominal pain. The incidence of this case was 1,5% of all appendicitis cases. The manifestation was not specific, and one of the treatment options was surgical with laparotomy or laparoscopy methods.
 Case presentation: A 10-year-old boy came to the outpatient clinic of gastroenterohepatology with a diagnosis of abdominal pain caused by chronic appendicitis differential diagnosis of chronic gastritis with abdominal pain, especially the pit of the stomach moving to the right waist since 3 months ago. Physical examination of the patient showed the general condition was moderate, conscious, and normal vital signs. Abdominal distension was absent, tenderness in the lower right abdomen was present, and the pain was present in the lower right abdomen. There was contralateral tenderness in the left lower abdomen. An appendicogram examination shows chronic appendicitis. The patient was consulted for pediatric surgery for appendectomy and later controlled to a surgical outpatient clinic after discharge.
 Conclusion: Chronic appendicitis usually shows unspecific manifestation and physical examination. Early diagnosis and surgical treatment are options to treat appendicitis in children.