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J Korean Surg Soc. 2004 Aug;67(2):152-156. Korean. Original Article.
Cho YH , Kim HY .
Department of Surgery, College of Medicine, Pusan National University, Busan, Korea.

PURPOSE: In the pediatric patient group, there are some obscurities of clinical history and physical examinations in a clinical settings of acute appendicitis. For this viewpoints, the advancement of appendicitis or postoerative complications can arise from a delayed diagnosis. We did this study for giving some helps to manage as comparing clinical features and radioloqical a studies accompanied. METHODS: 77 pediatric patients below 15-years-old who had an emergency appendectomy during the 24 months from Jan, 2001 to Dec, 2002 at the department of surgery, PNUH (Pusan National University Hospital) were selected. Retrospective analysis of the patients' cilinical characteristics was tarried out. Statistical test was calculated using the Fisher's exact and Chi-square test. RESULTS: 71 cases were found to be appendicitis and 6 cases (7.8%) had negative findings. There were 36 boys and 35 girls with sex ratio 1.03: 1. 32 cases of them (45.1%) were from 2 to 7 years old and 39 (54.9%) cases were perforated. In 33 cases, performed preoperative radiologic examinations, but there were no significant difference in a rate of negative appendectomy with regard to the radiological findings (P=0.179). Fever (above 38 degrees C) was observed in 37 cases(52.1%) and mainly in the perforated group (P=0.025). A various comparison of the data between the nonperforated and perforated appendicitis group is as follows: mean symptomatic duration; 1.3: 4.5 days, mean white blood cell's count; 14.4: 15.6x10(3)/mm(3), mean neutrophilic count; 84.9: 81.5%, total hospitalization period; 1.2: 6.1 days. Postoperative complications developed in 6 cases: wound infection in 4, adhesion in 2, and an intraabdominal abscess in 1. CONCLUSION: In the diagnosis and management of pediatric appendicitis, carefully detecting clinical history and physical examination seems to be very important. High fever(above 38 degrees C) is meaningful sign of advanced appendicitis. Recently, radiologic examinations are performed usually in many cases, but its indiscriminate applications must be considered as it's effectiveres and our medical environments.

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