College of Health Sciences Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Surg. 2023 Sep 14;23(1):278. doi: 10.1186/s12893-023-02191-4.
Acute appendicitis is the leading cause of emergency pediatric surgical admissions in the world. The diagnosis is may be difficult and is often dependent on clinical parameters. This study was aimed at reviewing the clinical presentations, the management and outcomes in children with inflamed and phlegmonous appendicitis with reference to the operative findings.
The records of 211 children 5 to 15 years of age who were operated for acute appendicitis with intra operative findings of inflamed or phlegmonous appendicitis who met inclusion criteria were entered and analyzed using SPSS (IBM) V.26. Descriptive and regression tests were done with p < 0.05 considered statistically significant.
Of 211 children with inflamed and phlegmonous appendicitis, the M: F was 1.48:1 with a median age of 11 years. 58.3% of them presented within 24 h with the commonest symptoms being right lower abdominal pain, anorexia, and vomiting (96.2%,96.2%, 85.3%,) respectively. 96.7% of them had right lower abdominal tenderness. 73% had neutrophils ≥ 75%, and of 171 patients who had abdominal ultrasound scan, 97.7% showed appendiceal diameter ≥ 6 mm. Intraoperatively 56.4% of them were found to have phlegmonous appendicitis. In a retrospective Pediatric Appendiceal Score, only 52.6% of patients fall into the high-risk category, who could be confirmed on preoperative clinical assessment. Postoperatively 90% of them discharged improved with a mean hospital stay of 2.26(SD = 0.9) days. There was no association between the sex of the child and the intraoperative finding of inflamed or phlegmonous appendicitis (p = 0.77).
Pediatric appendicitis affects more male children in their second decade of life. Most had phlegmonous appendicitis and presented within 24 h. Duration of illness has little effect on the progress of appendicitis. Surgical management is safe for inflamed and phlegmonous appendicitis with a reasonable hospital stay and a low rate of complications.
急性阑尾炎是世界范围内导致儿科急诊手术的主要原因。诊断可能很困难，通常依赖于临床参数。本研究旨在回顾伴有炎症和脓性阑尾炎的儿童的临床表现、治疗方法和结局，并参考手术发现。
对符合纳入标准的 211 例 5 至 15 岁儿童进行了手术治疗，术中发现有炎症或脓性阑尾炎，对其记录进行了输入和分析，使用的是 IBM SPSS 统计软件 V.26。采用描述性和回归检验，p<0.05 为有统计学意义。
211 例伴有炎症和脓性阑尾炎的儿童中，男女比例为 1.48:1，中位年龄为 11 岁。其中 58.3%的儿童在 24 小时内出现症状，最常见的症状依次为右下腹痛、食欲不振和呕吐（96.2%、96.2%、85.3%）。96.7%的儿童有右下腹部压痛。73%的儿童中性粒细胞≥75%，171 例接受腹部超声扫描的患者中，97.7%的阑尾直径≥6mm。术中发现 56.4%的阑尾为脓性阑尾炎。在回顾性儿科阑尾评分中，只有 52.6%的患者属于高风险类别，这在术前临床评估中可以得到证实。术后 90%的患者出院时病情好转，平均住院时间为 2.26（SD=0.9）天。儿童的性别与术中发现的炎症或脓性阑尾炎之间无相关性（p=0.77）。
儿科阑尾炎在男性儿童的第二十年更为常见。大多数为脓性阑尾炎，且在 24 小时内出现症状。疾病持续时间对阑尾炎的进展影响不大。手术治疗安全，炎症和脓性阑尾炎的住院时间合理，并发症发生率低。
