Appendicitis After Blunt Abdominal Trauma: Cause or Coincidence?

Abstract

The association of appendicitis and blunt abdominal trauma (BAT) is an exceptionally rare occurrence with a few case reports in the literature. The main question whether this association is a result of causative or coincidental relationship has not been evaluated among children. A retrospective clinical study was performed to clarify the pathogenesis, incidence, clinical characteristics and outcome of appendicitis diagnosed in children during the hospitalization period following blunt abdominal trauma (BAT). The records of 554 patients with BAT who were admitted to our unit between 1979 and 1993 inclusive were reviewed. Five patients (0.90%), 3 males and 2 females, with a mean age of 9.4 +/- 1.4 were found to have appendicitis. None of these patients had any signs or symptoms related to appendicitis prior to BAT. Bruising and rupture of the mesoappendix were noted in 3 patients while edema and hematoma of appendix and terminal ileum were found in two. Full recovery was achieved in all patients following appendicectomy. Our incidence of 0.90% is statistically significantly higher than the highest incidence rate of appendicitis stated in the literature during childhood (t-test for population proportion, t = 2.892; p < 0.05). We emphasise the possibility of a causative relationship between appendicitis and BAT depending on the clinical characteristics, operative findings, statistically significant high incidence rate and literature review.

Traumatic Appendicitis: A Case Report.

“…In both cases, blunt abdominal trauma has produced appendiceal edema with inflammation and hyperplasia of appendix lymphoid tissue, and then, obstruction of the appendiceal lumen, leading to acute appendicitis [4]. Ciftçi and al reported 5 cases of appendicitis occurring after abdominal trauma suggesting the same mechanism [2]. It is well known that intra-abdominal pressure increases in varying degrees in every blunt abdominal trauma case [5,6,7].…”

Systematic review of blunt abdominal trauma as a cause of acute appendicitis

“…In 1938, Fowler 2 reported only 48 cases out of 13,496 cases of appendicitis (0.3%) with a history of trauma. Ciftci et al 5 reported only five cases of appendicitis out of 554 patients (0.9%) following blunt abdominal trauma.…”

A review of the studies about appendicitis of the Turkish Pediatric Surgical Centers and a preliminary study to form a publishing index for pediatric appendicitis.

“…Karın ağrısı nedeniyle hastaneye getirilirken trafik kazası geçiren ve akut karın ön tanısıyla yapılan ameliyatta kökünden kopmuş enfekte apandiks saptanan 1 olgu (186) dışında; 7 merkezden toplam 15 olguda apandektomi yaralanma ile ilişkilendi-rilmiştir (85,113,114,137,138,153,171,186,224,316,317) . Bu olgulardan histopatolojik incelemede apandisit saptanan 5'inden 3'ü radyolojik incelemelerde apandisit tanısı konarak (171,153,224) , diğer 2'si ise künt karın yaralanması nedeniyle (137,138,316,317) ameliyat edilmiştir.…”

“…Bu 5 olgunun 3'ünde fekalit bulunması dikkat çekmiştir. Kalan 10 olgu künt karın yaralanması nedeniyle ameliyata alınmış; bunlardan 3'ünde apandiks mezo yırtılması (85) , 7'sinde ise apandikste ödem, hiperemi, hematom (85,113,114) nedeniyle apandektomi yapılmıştır. İki merkez verilerine dayanılarak künt karın yaralanmalı olgularda yaralanmış apandiks bulunma sıklıkları 5/554 (%0,9) ve 5/117 (%4) olarak belirlenmiştir (85,113,114) .…”