Gupta Rahul
Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
J Indian Assoc Pediatr Surg. 2025 Sep-Oct;30(5):600-610. doi: 10.4103/jiaps.jiaps_49_25. Epub 2025 Jun 16.
An appendicolith is a hard fecal concretion that can obstruct the appendix, leading to acute appendicitis. This study aimed to determine the prevalence of appendicoliths in pediatric patients with acute and complicated appendicitis. Secondarily, we aimed to evaluate its association with appendicular perforation peritonitis in pediatric patients.
This ambispective observational study was conducted from 2018 to 2023 in a pediatric surgery tertiary care teaching institute. The selected patients ( = 181) were those operated on by the author only. Patients were assigned to the appendicolith ( = 80) and no appendicolith groups ( = 101), and clinical features, laboratory data, ultrasound findings, and final diagnosis were compared. Student's -test and -score analyses were used to establish statistical significance.
Out of 181 patients, there were 129 males and 52 females (M: F = 2.48:1). The average age of the patients was 7.75 ± 3.35 years. The mean duration of symptoms was 3.62 ± 2.44 days. The mean leukocyte count was 14.24 ± 6.01 × 10/μL, and the mean neutrophil% age was 78.18 ± 9.95. The mean maximal diameter of the appendix was 9.16 ± 2.69 mm. The ultrasound evaluation was highly suggestive of appendicitis in 168 (92.82%) patients. There were 80 (44.2%) patients with appendicolith(s). When appendicolith group and the no appendicolith group were compared, statistically significant differences were present in the age at presentation (6.82 ± 3.39 vs. 8.49 ± 3.15), mean duration of symptoms (4.09 ± 2.9 days vs. 3.25 ± 1.94 days), diarrhea (9, 11.25% vs. 2, 1.98%), anemia (30, 37.5% vs. 18, 17.82%), mean maximal diameter of the appendix (9.99 ± 2.82 mm vs. 8.49 ± 2.38 mm), acute (uncomplicated) appendicitis (13, 16.25% vs. 36, 35.64), and complicated appendicitis (67, 83.75% vs. 65, 64.36%). There was no statistically significant difference in the mean leukocyte count and mean neutrophil% age between the two groups. The maximal diameter of appendicolith ≥5 mm (73) in comparison to the maximal diameter of appendicolith <5 mm (7) was significantly associated with a larger percentage of patients with perforated appendicitis (60, 82.19%) than nonperforated appendicitis (3, 42.86%).
The presence of an appendicolith is associated with prolonged abdominal pain and higher rates of appendicular perforation in pediatric patients with acute appendicitis. The size of the largest appendicolith ≥5 mm is an exacerbating factor for appendicular perforation peritonitis.
阑尾粪石是一种坚硬的粪便结石，可阻塞阑尾，导致急性阑尾炎。本研究旨在确定急性和复杂性阑尾炎患儿中阑尾粪石的患病率。其次，我们旨在评估其与小儿阑尾穿孔性腹膜炎的相关性。
本回顾性观察研究于2018年至2023年在一家儿科外科三级护理教学机构进行。所选患者（n = 181）均为由作者本人进行手术的患者。将患者分为阑尾粪石组（n = 80）和无阑尾粪石组（n = 101），并比较临床特征、实验室数据、超声检查结果和最终诊断。采用学生t检验和z评分分析来确定统计学意义。
181例患者中，男性129例，女性52例（男：女 = 2.48:1）。患者的平均年龄为7.75 ± 3.35岁。症状的平均持续时间为3.62 ± 2.44天。平均白细胞计数为14.24 ± 6.01×10⁹/μL，平均中性粒细胞百分比为78.18 ± 9.95。阑尾的平均最大直径为9.16 ± 2.69 mm。超声评估高度提示168例（92.82%）患者患有阑尾炎。有80例（44.2%）患者存在阑尾粪石。比较阑尾粪石组和无阑尾粪石组时，在就诊年龄（6.82 ± 3.39岁 vs. 8.49 ± 3.15岁）、症状平均持续时间（4.09 ± 2.9天 vs. 3.25 ± 1.94天）、腹泻（9例，11.25% vs. 2例，1.98%）、贫血（30例，37.5% vs. 18例，17.82%）、阑尾平均最大直径（9.99 ± 2.82 mm vs. 8.49 ± 2.38 mm）、急性（非复杂性）阑尾炎（13例，16.25% vs. 36例，35.64%）和复杂性阑尾炎（67例，83.75% vs. 65例，64.36%）方面存在统计学显著差异。两组之间的平均白细胞计数和平均中性粒细胞百分比无统计学显著差异。与最大直径<5 mm的阑尾粪石（7例）相比，最大直径≥5 mm的阑尾粪石（73例）与穿孔性阑尾炎患者的比例（60例，82.19%）显著高于非穿孔性阑尾炎患者（3例，42.86%）相关。
阑尾粪石的存在与急性阑尾炎患儿的腹痛延长和阑尾穿孔率较高有关。最大阑尾粪石尺寸≥5 mm是阑尾穿孔性腹膜炎的一个加重因素。
