Alaedeen Diya I, Cook Marc, Chwals Walter J
Department of Surgery, Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
J Pediatr Surg. 2008 May;43(5):889-92. doi: 10.1016/j.jpedsurg.2007.12.034.
A fecalith is a fecal concretion that can obstruct the appendix leading to acute appendicitis. We hypothesized that the presence of a fecalith would lead to an earlier appendiceal perforation.
Between January 2001 and December 2005, the charts of all patients younger than 18 years old who underwent appendectomy at our institution were reviewed. Duration of symptoms and timing between presentation and operation were noted along with radiologic, operative, and pathologic findings.
There were 388 patients who met the study criteria. A fecalith was present in 31% of patients (n = 121). The appendix was perforated in 57% of patients who had a fecalith vs 36% in patients without a fecalith (P < .001). The overall rate of interval appendectomies was 12%. A fecalith was present on the initial radiologic studies of 36% of the patients who had interval appendectomies, and the appendix was perforated significantly sooner in these patients when compared to those without a fecalith (91 vs 150 hours; P = .036).
The presence of fecalith is associated with earlier and higher rates of appendiceal perforation in pediatric patients with acute appendicitis. An expedient appendectomy should therefore be performed in the pediatric patient with a radiologic evidence of fecalith.
粪石是一种粪便结石，可阻塞阑尾导致急性阑尾炎。我们推测粪石的存在会导致阑尾穿孔更早发生。
回顾2001年1月至2005年12月期间在我院接受阑尾切除术的所有18岁以下患者的病历。记录症状持续时间以及就诊与手术之间的时间，同时记录放射学、手术和病理学检查结果。
有388例患者符合研究标准。31%的患者（n = 121）存在粪石。有粪石的患者中57%发生阑尾穿孔，而无粪石的患者中这一比例为36%（P <.001）。间隔期阑尾切除术的总体发生率为12%。在间隔期阑尾切除术患者的初始放射学检查中，36%的患者存在粪石，与无粪石的患者相比，这些患者的阑尾穿孔明显更早（91小时对150小时；P =.036）。
在患有急性阑尾炎的儿科患者中，粪石的存在与阑尾穿孔更早发生及更高发生率相关。因此，对于有放射学证据显示存在粪石的儿科患者，应尽早进行阑尾切除术。
