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http://dx.doi.org/10.14776/piv.2018.25.1.1

Acute Appendicitis in Children and Adolescents: Factors Associated with Perforation and the Causative Organism  

Lee, Sol (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
Kwon, Hyuck Jin (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
Ahn, Soo Min (Department of Pediatric Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
Lee, Kwan Seop (Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
Kim, Kwang Nam (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
Publication Information
Pediatric Infection and Vaccine / v.25, no.1, 2018 , pp. 1-7 More about this Journal
Abstract
Purpose: This study aimed to determine which factors are related to perforated appendicitis. We also conducted a survey to identify the causative organism. Methods: From January 2011 to December 2014, 569 pediatric patients (322 male) younger than 19 years old who underwent an appendectomy due to acute appendicitis at Hallym University Sacred Heart Hospital were enrolled. Patients' medical records were reviewed retrospectively to determine their clinical manifestations, laboratory and imaging results, and pathogens. Results: About 127 patients (22%) had perforated appendicitis. The rate of perforated appendicitis in preschool, late childhood, and adolescent ages were 50%, 27%, and 16.8%, respectively. The risk factors of perforation were high C-reactive protein levels and the presence of appendiceal fecalith (P<0.001). Of the 24 samples of peritoneal fluid and periappendiceal pus that were collected intraoperatively, 16 were culture positive. The most common pathogen was Escherichia coli (n=10), and others were Pseudomonas aeruginosa, Streptococcus spp., and Staphylococcus spp. Conclusions: The perforation rate of appendicitis among patients younger than 5 years old was 50%, and this decreased in proportion with age. Clinicians should be aware of the possibility of perforation when patients with appendicitis have high C-reactive protein levels or the presence of appendiceal fecalith on imaging.
Keywords
Appendicitis; Child; Adolescent;
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1 Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ. Appendicitis and pelvic abscess. In: Cherry JD, editor. Feigin & Cherry's textbook of pediatric infectious diseases. 7th ed. Philadelphia: Saunders Co, 2013:679-89.
2 Aiken JJ, Oldham KT. Acute appendicitis. In: Kliegman RM, Nelson WE, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier, 2016:1887-93.
3 Mc Cabe K, Babl FE, Dalton S; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Management of children with possible appendicitis: a survey of emergency physicians in Australia and New Zealand. Emerg Med Australas 2014;26:481-6.   DOI
4 Chen CY, Chen YC, Pu HN, Tsai CH, Chen WT, Lin CH. Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics. Surg Infect (Larchmt) 2012;13:383-90.   DOI
5 Adams DH, Fine C, Brooks DC. High-resolution real-time ultrasonography. A new tool in the diagnosis of acute appendicitis. Am J Surg 1988;155:93-7.   DOI
6 Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am 1996;14:653-71.   DOI
7 Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers for acute appendicitis in children: are they helpful? J Pediatr Surg 2007;42:773-6.   DOI
8 Naiditch JA, Lautz TB, Daley S, Pierce MC, Reynolds M. The implications of missed opportunities to diagnose appendicitis in children. Acad Emerg Med 2013;20:592-6.   DOI
9 Choi JY, Ryoo E, Jo JH, Hann T, Kim SM. Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis. Korean J Pediatr 2016;59:368-73.   DOI
10 Horwitz JR, Gursoy M, Jaksic T, Lally KP. Importance of diarrhea as a presenting symptom of appendicitis in very young children. Am J Surg 1997;173:80-2.   DOI
11 Abou Merhi B, Khalil M, Daoud N. Comparison of Alvarado score evaluation and clinical judgment in acute appendicitis. Med Arch 2014;68:10-3.   DOI
12 Bansal S, Banever GT, Karrer FM, Partrick DA. Appendicitis in children less than 5 years old: influence of age on presentation and outcome. Am J Surg 2012;204:1031-5.   DOI
13 Peng YS, Lee HC, Yeung CY, Sheu JC, Wang NL, Tsai YH. Clinical criteria for diagnosing perforated appendix in pediatric patients. Pediatr Emerg Care 2006;22:475-9.   DOI
14 Ngim CF, Quek KF, Dhanoa A, Khoo JJ, Vellusamy M, Ng CS. Pediatric appendicitis in a developing country: what are the clinical predictors and outcome of perforation? J Trop Pediatr 2014;60:409-14.   DOI
15 Mathews EK, Griffin RL, Mortellaro V, Beierle EA, Harmon CM, Chen MK, et al. Utility of immature granulocyte percentage in pediatric appendicitis. J Surg Res 2014;190: 230-4.   DOI
16 Bonadio W, Peloquin P, Brazg J, Scheinbach I, Saunders J, Okpalaji C, et al. Appendicitis in preschool aged children: regression analysis of factors associated with perforation outcome. J Pediatr Surg 2015;50:1569-73.   DOI
17 Hung MH, Lin LH, Chen DF. Clinical manifestations in children with ruptured appendicitis. Pediatr Emerg Care 2012;28:433-5.   DOI
18 Gladman MA, Knowles CH, Gladman LJ, Payne JG. Intraoperative culture in appendicitis: traditional practice challenged. Ann R Coll Surg Engl 2004;86:196-201.
19 Foo FJ, Beckingham IJ, Ahmed I. Intra-operative culture swabs in acute appendicitis: a waste of resources. Surgeon 2008;6:278-81.   DOI
20 Park KW. Appendicitis in children. Korean J Pediatr 1993; 36:1044-6.
21 Chan KW, Lee KH, Mou JW, Cheung ST, Sihoe JD, Tam YH. Evidence-based adjustment of antibiotic in pediatric complicated appendicitis in the era of antibiotic resistance. Pediatr Surg Int 2010;26:157-60.   DOI
22 Boueil A, Guegan H, Colot J, D'Ortenzio E, Guerrier G. Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island. Asian J Surg 2015;38:242-6.   DOI
23 Nichols RL. Infections following gastrointestinal surgery: intra-abdominal abscess. Surg Clin North Am 1980;60: 197-212.   DOI
24 Condon RE. Rational use of prophylactic antibiotics in gastrointestinal surgery. Surg Clin North Am 1975;55: 1309-18.   DOI