Pogorelić Zenon, Babić Vlade, Bašković Marko, Ercegović Vladimir, Mrklić Ivana
Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia.
Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia.
J Clin Med. 2024 May 29;13(11):3198. doi: 10.3390/jcm13113198.
The role of infestation in the context of appendicitis is largely overlooked, but is considered an unexpected and significant appendicectomy finding. The aim of this study was to investigate the frequency of findings in appendectomies and to evaluate the clinical and histopathologic features of patients with -associated acute appendicitis and those with appendiceal infestation. The medical records of all children who underwent an appendectomy in two large pediatric centers in Croatia between 1 January 2009 and 1 January 2024 were retrospectively reviewed. Of 6359 appendectomies, 61 (0.96%) children were diagnosed with on histopathology and included in further analysis. The groups were compared with regard to demographic characteristics, laboratory values, clinical features and histopathological findings. : The incidence of enterobiasis fluctuated slightly in the individual study years, but was constant overall. The median age of all patients was 11 years (IQR 8.5, 13), with females predominating (60.7%). Acute appendicitis was observed in 34% of the appendiceal species. The patients with infestation, without appendicitis, were younger (9 years (IQR 8, 13) vs. 12 years (IQR 10, 15); = 0.020), had longer duration of symptoms (36 h (IQR, 12, 48) vs. 24 h (IQR, 12, 36); = 0.034), lower body temperature (37 °C (IQR 36.8, 37.4) vs. 37.6 °C (IQR, 37, 38.6) = 0.012), lower Appendicitis Inflammation Response (AIR) score (3 (IQR 2, 5) vs. 7 (IQR 5, 9.5) < 0.001), lower incidence of rebound tenderness (57.1% vs. 20%; = 0.003) and less frequent vomiting (12.5% vs. 47.6%; = 0.004) compared to the patients with -associated acute appendicitis. Acute inflammatory markers in the laboratory showed significantly higher values in the group of patients with acute appendicitis: C-reactive protein ( = 0.009), White blood cells ( = 0.001) and neutrophils ( < 0.001). Eosinophilia was not found in any of the groups, although eosinophil counts were significantly higher in children who had infestation than in those with -related appendicitis (2.5% (IQR 0.9, 4.3) vs. 1.8% (IQR 0.7, 2.1); = 0.040). : Pediatric surgeons should consider infestation as a differential diagnosis when removing a vermiform appendix. Younger age, longer duration of symptoms, lower body temperature, lower AIR score, lower diameter of the appendix and normal laboratory inflammatory markers could predict infection in children presenting with right iliac fossa pain and avoid unnecessary appendectomy.
蛔虫感染在阑尾炎背景下的作用在很大程度上被忽视了，但它被认为是阑尾切除术中一个意外且重要的发现。本研究的目的是调查阑尾切除术中该发现的频率，并评估与蛔虫相关的急性阑尾炎患者和阑尾蛔虫感染患者的临床及组织病理学特征。回顾性分析了2009年1月1日至2024年1月1日期间在克罗地亚两个大型儿科中心接受阑尾切除术的所有儿童的病历。在6359例阑尾切除术中，61例（0.96%）儿童在组织病理学检查中被诊断为蛔虫感染，并纳入进一步分析。比较了两组在人口统计学特征、实验室检查值、临床特征和组织病理学发现方面的情况。结果：蛔虫病的发病率在各研究年份略有波动，但总体保持稳定。所有患者的中位年龄为11岁（四分位间距8.5，13），女性占多数（60.7%）。34%的阑尾标本观察到急性阑尾炎。与蛔虫相关急性阑尾炎患者相比，无阑尾炎的蛔虫感染患者年龄更小（9岁（四分位间距8，13）对12岁（四分位间距10，15）；P = 0.020），症状持续时间更长（36小时（四分位间距12，48）对24小时（四分位间距12，36）；P = 0.034），体温更低（37℃（四分位间距36.8，37.4）对37.6℃（四分位间距37，38.6）；P = 0.012），阑尾炎炎症反应（AIR）评分更低（3（四分位间距2，5）对7（四分位间距5，9.5）；P < 0.001），反跳痛发生率更低（57.1%对20%；P = 0.003），呕吐频率更低（12.5%对47.6%；P = 0.004）。实验室检查中，急性炎症标志物在急性阑尾炎患者组中显著更高：C反应蛋白（P = 0.009）、白细胞（P = 0.001）和中性粒细胞（P < 0.001）。尽管蛔虫感染儿童的嗜酸性粒细胞计数显著高于与蛔虫相关阑尾炎儿童（2.5%（四分位间距0.9，4.3）对1.8%（四分位间距0.7，2.1）；P = 0.040），但两组均未发现嗜酸性粒细胞增多。结论：小儿外科医生在切除阑尾时应将蛔虫感染作为鉴别诊断。年龄较小、症状持续时间较长、体温较低、AIR评分较低、阑尾直径较小以及实验室炎症标志物正常可预测右下腹疼痛儿童的蛔虫感染，避免不必要的阑尾切除术。
