Clinical Review of Treatment of Acute Appendicitis in Children

Ko, Sung Guen; Cho, Sueng Yeon; Lee, Jung Nam

Abstract

Acute appendicitis in children under the age of 12 has remained the surgical emergency condition with the highest percentage of misdiagnosis leading to removal of a normal appendix. From January 1994 to April 1997, 312 children (176 boys, 136 girls) were admitted to Jun-ang Gil Hospital with the impression of acute appendicitis. The average age was 8.6 years (2 to 12 years). We reviewed medical records retrospectively for demographics, presenting signs, symptoms, findings of abdominal ultrasonography (USG) and barium enemas, and surgical results. The patients were divided in 2 groups as follows: group I (n=144) received immediate operations without further evaluation, group II (n=168) was treated after a delay for observation and/or special studies (USG and/or barium enema). Group II was subdivided into Group IIa (n=119) (treatment after study) and Group IIb (n=49)(treatment by clinical observations only). In group I, 124 patients were confirmed intraoperatively as having acute appendicitis, and 20 cases were not. In IIa, 36 patients underwent exploratory surgery and 30 cases revealed acute appendicitis. The remaining 83 patients were discharged because of symptomatic relief. In group IIb, 43 patients underwent exploratory surgery and acute appendicitis was revealed in 35. The diagnostic accuracies of groups were 86%, 95% and 84%. The sensitivity, specificity and diagnostic accuracy of an abdominal ultrasonography (n=105) were 96.1%, 82.1% and 92.4%, respectively. Those of a barium enema (n=63) were 94.7%, 100%, and 95.2% respectively. When both modalities were used (n=49), the results were 95.6%, 100% and 95.9%, respectively. The frequencies of a perforated appendicitis had no difference among the groups. In conclusion, in a child suspected of having acute appendicitis, if there are no apparent toxic signs or panperitonitis, surgical observation, USG, and/or a barium enema can decrease the number of unnecessary appendectomy without increasing the risk of perforation.