Appendectomy in children

Hippokratia 2000, 4(2):79-84

B. Kasselas, B. Lambropoulos, Ch. Chaidos, Ch. Kasselas, M. Papoutsakis, S. Gavopoulos, N. Nikandrou, G. Grigoriadis


Acute appendicitis is the most frequent surgical problem that occurs in childhood. The purpose of our study is to describe the characteristics of acute appendicitis in children, to discuss difficulties of diagnosis and treatment, as well as to compare our findings to those of current literature.In a period of 10 years (1990-1999) 4168 children were operated in our department with a diagnosis of an acute appendicitis. The children were from 2 to 14 years of age and 2834 (68%) of them were boys while 1334 (32%) girls. Blood tests, urinalysis, plain film of abdomen were taken in all cases. Moreover, biochemical tests, x-ray of the chest as well as ultrasound examination and CT of the abdomen were done in neglected or contradictory cases. All the vermiform appendices were histologically examined. 12% (500) of the appendices had no evidence of inflammation, 73% (3043) showed findings of acute appendicitis and 25% (625 were perforated) showed findings of perforation and peritonitis. Leucocytosis was found in 70% of the patients whithout acute appendicitis, in 72% of the patients with acute appendicitis and in 93% of those who had perforation and peritonitis. Peritoneal lavage, placement of drains, starting of feeding, administration of antibiotics, complications and the duration of the hospital treatment depended on the surgical findings. The average length of hospital stay was 4 days for cases with acute appendicitis and 8 days for those with peritonitis.Despite recent advances in laboratory investigation and screening tests the diagnosis of acute appendicitis in children is still difficult and is mainly based on history and physical examination. We expect our conclusions to be useful to physicians who are confronted with such problems in children.