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Appendicitis in infants – a 5 year review

Aline Vaz-Silva1, Filipa Carlota Marques2, Maria Knoblich1, Cristina Borges, Paolo Casella1

1 Serviço de Cirurgia Pediátrica, H. D. Estefânia, CHLC E.P.E.;
2 Serviço de Pediatria Médica, HSFX, CHLO E.P.E.

4th World Congress of Pediatric Surgery, 13 a 16 de Outubro 2013, Berlim. (poster)


Background: Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is uncommon in children under 3 years old. Clinical presentation is often atypical, which can lead to a delay in diagnosis. The aim of this study was to identify the presenting symptoms and signs in children under three years of age who underwent surgery for appendicitis, and analyze the outcome.

Methods:  Review of medical data of children under 3 years of age who underwent appendectomy for appendicitis between October 2006 to October 2011 in a single terciary pediatric hospital. Data gathered: age at operation, gender, duration of symptoms, care sought prior to admission for appendectomy, antibiotic treatment prior to admission for appendectomy, transference from other health care facility, signs and symptoms at time of admission, laboratory and imaging investigation, intraoperative diagnosis, length of postoperative hospital stay and complications.

Results: There were 33 patients in this series, with the mean age of 31 months; 55% male. Duration of symptoms was more than 48h in 64%; 54% had more than one previous medical evaluation , 30% were treated with antibiotics for the same complaints; 70 % were transferred from another health care facility. The most common presenting symptom was abdominal  pain (90,9%), the most commom sign was fever (90,9%). Leukocytosis in 84,2% and raised C reactive protein in 94,7%. All patients had an abdominal ultrasound. Intraoperatively 91% had appendiceal perforation, abscess or diffuse peritonitis. Median length of stay was 7 days. There were 7 complications: 3 wound infections, 2 abscesses, 2 small bowel obstruction (1 underwent surgery). There were no deaths.

Conclusion: appendicitis in small children is a diagnostic problem, with subsequent delay in diagnosis and almost universal perforation rate. It should be considered in the differential diagnosis of children under 3 years of age who present with abdominal pain and fever.