Ray Saugata, Gupta Umesh K, Prakash Gautam, Kumar Shesh
Department of Surgery, Midnapore Medical College and Hospital, Midnapore, IND.
Department of Pediatric Surgery, Uttar Pradesh University of Medical Sciences, Etawah, IND.
Cureus. 2023 Sep 5;15(9):e44697. doi: 10.7759/cureus.44697. eCollection 2023 Sep.
Background Acute appendicitis (AA) is the most common surgical emergency worldwide. Delay in diagnosis of disease often leads to serious complications such as perforation appendicitis (PA) and gangrenous appendicitis (GA). Aims and objectives The purpose of the study is to document clinicopathological outcomes in pediatric age group patients in a tertiary health care center. Material and method This study was a prospective observation study of 50 patients with pediatric appendicitis who had undergone emergency appendectomy from January 2022 to December 2022. All pediatric patients below 15 years of age with a diagnosis of AA were included. Institute ethical permission was granted before the study, and parent consent was taken for the surgery and also for inclusion in the study. After proper resuscitation, all patients underwent appendectomy, and necessary specimens were sent for histological examination. Based on histopathology reports, all patients were classified into four groups: AA, PA, GA, and normal appendix (NA). Results Out of 50 patients, 33 (66%) patients were males and 17 (34%) patients were females. The mean age of the patients was 10.22 ± 2.73 years. The mean age of AA, PA, GA, and NA patients were 10.25 ± 2.6 years, 9.78 ± 2.99 years, 10.00 ± 4.6 years, and 12.00 ± 2.8 years, respectively. The mean duration of symptoms at the time of hospital admission was 2.42 ± 0.97 days for histopathologically proven AA patients, 4.67 ± 2.1 days for GA patients, 2.8 ± 0.83 for PA patients, and one day for NA patients. Overall clinical presentation was right iliac fossa (RIF) pain in 36 (72%) patients, migration of pain in 31 (62%) patients, anorexia in 37 (74%) patients, nausea and vomiting in 43 (86%) patients fever in 26 (52%) patients, RIF tenderness in 50 (100%) patients, rebound tenderness in 39 (78%) patients, guarding in 19 (38%) patients, Psoas's sign in nine (18% patients), and Rovsing's sign in 19 (38%) patients. On histopathological examination of the sent specimen, AA was found in 36 (72%) patients, PA was found in nine (18%) patients, GA was found in three (6%) patients, and NA was found in two (4%) patients. Wound infection was the most common complication and was found in five (10%) patients. The average duration of hospital stay for AA, PA, GA, and NA was 4.33 ± 1.04 days, 9.56 ± 4.2 days, 12.33 ± 8.5 days, and 3.50 ± 0.71 days, respectively. Conclusion The appendicular disease is common in teenage male children. Fever, dehydration, and rebound tenderness at the RIF are clinically significant findings. Duration of symptoms at the time of diagnosis, post-appendectomy complication, and duration of hospital stay significantly correlated with histopathological findings.
急性阑尾炎（AA）是全球最常见的外科急症。疾病诊断延误常导致严重并发症，如穿孔性阑尾炎（PA）和坏疽性阑尾炎（GA）。
本研究的目的是记录三级医疗保健中心儿科患者的临床病理结果。
本研究是一项前瞻性观察研究，对2022年1月至2022年12月期间接受急诊阑尾切除术的50例小儿阑尾炎患者进行研究。纳入所有15岁以下诊断为AA的儿科患者。在研究前获得了机构伦理许可，并获得了家长对手术及纳入研究的同意。经过适当复苏后，所有患者均接受了阑尾切除术，并将必要的标本送去进行组织学检查。根据组织病理学报告，所有患者分为四组：AA、PA、GA和正常阑尾（NA）。
50例患者中，33例（66%）为男性，17例（34%）为女性。患者的平均年龄为10.22±2.73岁。AA、PA、GA和NA患者的平均年龄分别为10.25±2.6岁、9.78±2.99岁、10.00±4.6岁和12.00±2.8岁。组织病理学证实为AA的患者入院时症状的平均持续时间为2.42±0.97天，GA患者为4.67±2.1天，PA患者为2.8±0.83天，NA患者为1天。总体临床表现为右下腹（RIF）疼痛36例（72%），疼痛转移31例（62%），厌食37例（74%），恶心呕吐43例（86%），发热26例（52%），RIF压痛50例（100%），反跳痛39例（78%），肌紧张19例（38%），腰大肌征9例（18%），罗夫辛征19例（38%）。对送检标本进行组织病理学检查，发现AA 36例（72%），PA 9例（18%），GA 3例（6%），NA 2例（4%）。伤口感染是最常见的并发症，5例（10%）患者出现。AA、PA、GA和NA的平均住院时间分别为4.33±1.04天、9.56±4.2天、12.33±8.5天和3.50±0.71天。
阑尾疾病在青少年男性儿童中常见。发热、脱水和RIF反跳痛是具有临床意义的表现。诊断时症状持续时间、阑尾切除术后并发症和住院时间与组织病理学结果显著相关。
