Clinical Characteristics of Acute Appendicitis in Children of 3 Years of Age or Less

Ryu, Ji Ho; Ryoo, Eell; Lim, Yong Su; Kim, Jae Kwang; Hyun, Sung Youl; Lee, Gun; Yang, Hyuk Jun; Jin, Wook

Abstract

BACKGROUND: In younger children, early diagnosis of acute appendicitis can be difficult because patients may not be able to provide a good history of their symptoms and the etiologies of the abdominal pain is often unclear. Therefore, the diagnosis is may be delayed and may be made after perforation has occurred.
METHODS
The cases of 20 children of 3 years of age or less who underwent appendectomies due to appendicitis from January 1995 to March 2000 were retrospectively reviewed. Data were gathered including seasonal variation, gender, mean age, presenting signs and symptoms, physical signs, diagnostic methods, WBC counts, postoperative complications and length of postoperative hospital stay.
RESULTS
The male-to-female ratio was 1.5:1. Fifteen cases were diagnosed after perforation had occurred, and 5 cases were nonperforated. The mean age was 29.6(+/-5.5) months; 60% were males(12/20). The most common presenting symptom was abdominal pain(95%). The most common signs was abdominal tenderness; especially, muscle guarding was more common in the perforated group(100% vs. 0%). The mean duration of symptoms prior to visiting the ED and the average length of hospital stay were 4.4 days and 10.1 days in the perforated group and 2.2 days and 4.2 days in the nonperforated group, retrospectively.
CONCLUSION
In children of 3 years of age or less, when abdominal pain is persistent without response to conservative treatment and there is associated abdominal tenderness, appendicitis must be considered. especially, when there are fever, diarrhea and muscle guarding, perforated appendicitis must be considered.