ACUTE APPENDICITIS IN CHILDREN

CORRELATION OF CLINICAL DATA WITH HISTOPATHOLOGICAL FINDINGS

Abstract

Objective: The study was conducted to identify clinical features significantly
associated with histopathologically proven appendicitis in children. Design: Cross-Sectional
Observational. Place and Duration of study: This study was conducted in Department of
Paediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012.
Patients and methods: Children aged 2 to 14 years who underwent appendectomy for acute
appendicitis during the study period were included. Patients who had appendectomy for any
reason other than appendicitis were excluded. Presenting symptoms, signs, hospital course of
patients and histopathological diagnosis were recoded. Data was analyzed by using SPSS.
Sensitivity, specificity, positive predictive value and negative predictive value for each symptom
and sign were calculated. Results: Out of 1420 patients who were evaluated during the study
period for acute abdominal pain, 70(5%) were diagnosed with acute appendicitis. Four patients
left against medical advice so 66 patients were studied. Patients were divided into acute
appendicitis and non-inflamed appendix group on the basis of histopathology of resected
appendix. Acute appendicitis was confirmed histologically in 43 (65%) cases and perforated
appendicitis was found in 8 (12%). No evidence of acute inflammation was found in 15 (22%)
cases. Among clinical features only involuntary guard (p-value 0.01) and rebound tenderness
(p-value 0.004) were significantly different among acute appendicitis and non-inflamed appendix
group. Total leukocyte count more than 11,000 was significantly higher in acute appendicitis
group. Conclusions: The cornerstone of diagnosis of acute appendicitis in children is thorough
history and meticulous physical examination. Involuntary guard, rebound tenderness and total
leukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases of
appendicitis.