Acute appendicitis in young children less than 5 years: review article

Almaramhy, Hamdi H.

doi:10.1186/s13052-017-0335-2

Cited by 159 publications

(189 citation statements)

References 93 publications

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“…Delayed intervention leads to dramatic complications such as perforation and abscess formation while rushing to surgery is associated with a high negative appendectomy of up to 15%–30% 2. Diagnosis of appendicitis in children is challenging, not only because there are so many other nonsurgical conditions that mimic appendicitis,1 but also because there are difficulties in communication and examination 3…”

Section: Introductionmentioning

confidence: 99%

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Sayed

Zeidan

Fahmy

et al. 2017

TCRM

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BackgroundDiagnosis of appendicitis in children is clinically challenging. Computed tomography (CT) is the gold standard for diagnosis; however, radiation exposure early in life is a concern with this technique. Therefore, in this study, we aimed to evaluate the diagnostic reliability of low-dose CT, pediatric appendicitis score (PAS), and abdominal ultrasound (US) in children with acute appendicitis, to reach a safe diagnosis.Patients and methodsThis retrospective study was conducted on 140 children who were admitted with clinically suspected acute appendicitis (45 with positive appendicitis and 95 children with negative appendicitis). Low-dose CT was performed, and PAS was retrospectively calculated for all subjects. US was initially performed for 38 subjects. All results were compared with the final diagnosis reached by an operative, histopathological analysis and follow-up.ResultsLow-dose CT showed a sensitivity, specificity, and accuracy of 97.8%, 100%, and 99.3%, respectively. At a cutoff value ≥5, PAS showed a sensitivity, specificity, and accuracy of 95%, 84%, and 89%, respectively. Abdominal US examination showed sensitivity, specificity, and accuracy of 55.6%, 85%, and 71%, respectively. Implementing Poortman’s model resulted in higher accuracy (92%) of US. There was a significant difference in accuracy between a low-dose CT and PAS on one side and between Poortman’s model and US examination on the other side. A diagnostic scheme was suggested using PAS as the excluding tool (PAS ≤2 send home and ≥7 send directly to operation) followed by US examination and reserving low-dose CT for inconclusive cases. This scheme would eliminate the use of CT for at least 33.7% and in 7 cases who had initial US examination.ConclusionAlthough CT remains the most accurate and less operator-dependent diagnostic tool for pediatric appendicitis, the radiation hazards could however be minimized using PAS as an excluding tool and US as the primary imaging modality followed by low-dose CT for inconclusive cases only.

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Section: Introductionmentioning

confidence: 99%

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Sayed

Zeidan

Fahmy

et al. 2017

TCRM

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“…The ease of perforation in this age group is associated with some peculiar anatomical features such as thin‐walled appendix and inadequate omental barrier. A recent report has pegged the rate of missed diagnosis in children of 3 years and below at 70%‐100% and further revealed that as age decreases, there is a 5‐fold increase in the risk of developing appendicitis complication as a consequence of misdiagnosis . Clinical manifestations of sepsis before appendectomy surgery, including abnormal body temperature, tachycardia, tachypnea, WBC < 5000 or more than 15 000, and abnormal forms of tuberculosis .…”

Section: Discussionmentioning

confidence: 99%

“…The most common symptom is abdominal pain. About 1%‐8% of children with abdominal pain have acute appendicitis . In children younger than 3 years, fever, diarrhea, and vomiting are the most common symptoms of appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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Sepsis after non‐perforated acute appendicitis

Faraji-Goodarzi

2019

Clinical Case Reports

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Key Clinical Message Appendicitis is a worm‐like appendage whose base is located on the posterior side of the inner cecum. Acute appendicitis is uncommon in children younger than 5 years old. The patient was a 1.5‐year‐old boy who was admitted to the hospital with a primary complaint of fever, diarrhea, and vomiting. A pathological report of acute puffiness appendicitis with peri appendicitis was confirmed. After two weeks of treatment, the patient was discharged with an good general condition.

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“…However, pediatric patients are most frequently affected (60%), probably reflecting a difference in the pathological aspects of this condition between both groups. While in adults the omentum can contain the inflammation affecting the appendix, in children the omentum is underdeveloped and unable to limit purulent leakage [10, 11]. Thus, children are more prone to develop peritonitis compared to adult patients.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Empyema as Rare Complication of an Appendicular Mass: A Case Study and Review of the Literature

Vasquez-Rios

Calixto-Aguilar

Pajuelo

et al. 2018

Case Reports in Pediatrics

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Introduction Thoracic empyema is an infrequent complication of appendicitis that has rarely been reported in the literature. Case Presentation and Review of the Literature The case of a 11-year-old boy who was admitted for medical management of an appendicular mass is presented. His clinical course was complicated by the development of an appendicular abscess and an extensive right-sided empyema. A comprehensive review of the literature was conducted including the most representative cases. The data were collected and analyzed by two independent investigators. Ten cases were found. Most patients were young individuals (mean age: 25.1 years; male : female ratio: 0.5). Risk factors for thoracic empyema included pregnancy (10%) and age (60%). The most frequent organisms isolated were Escherichia coli, Bacteroides spp., and Klebsiella spp. The survival rate was 100%. Conclusion Thoracic empyema should be considered a potential cause of respiratory distress in patients with appendicitis. Furthermore, the abdomen should be carefully evaluated as a source of infection in patients with thoracic empyema without an underlying lung disease.

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Acute appendicitis in young children less than 5 years: review article

Cited by 159 publications

References 93 publications

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Sepsis after non‐perforated acute appendicitis

Thoracic Empyema as Rare Complication of an Appendicular Mass: A Case Study and Review of the Literature

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