Appendicitis in the First Three Years of Life

Barker, Andrew; Davey, R. B.

doi:10.1111/j.1445-2197.1988.tb06241.x

Cited by 31 publications

(26 citation statements)

References 9 publications

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“…The mean age of the study population was 10 years or older in most of these publications. Acute appendicitis is the most frequent reason for laparotomy in children; however, it is relatively rare in babies and very young children and less than 5 % of all pediatric appendicitis is diagnosed in children 5 years and younger [10][11][12][13][14]. The spectrum of differential diagnoses in children with acute abdominal pain is wide, ranging from emergent surgical conditions, various non-surgical and infectious conditions, and self-limiting conditions.…”

Section: Introductionmentioning

confidence: 97%

Diagnostic value of CT compared to ultrasound in the evaluation of acute abdominal pain in children younger than 10 years old

2015

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To assess the diagnostic value of ultrasound compared to CT in evaluating acute abdominal pain of different causes in children 10 years of age and under, hospital records and imaging files of 4052 patients under age of 10 who had imaging for abdominal pain were reviewed. One-hundred-thirty-two patients (3 %), (74 males/58 females) who underwent ultrasound and CT within 24 h were divided by age: group I, ages 0-48 months (25 patients); group II, 49-84 months (53 patients); and group III, 85-120 months (54 patients). Diagnoses at ultrasound, CT, and discharge were compared. Cases of a change in diagnosis following CT and impact of the changed diagnosis on patient management were assessed. Non-diagnostic ultrasound or a diagnostic conundrum was present in a small percentage (3 %) of our patients. In the group of patients imaged with two modalities, CT changed the diagnosis in 73/132 patients (55.3 %). Patient management changed in 63/132 patients (47.7 %). CT changed the diagnosis in 46/64 patients with surgical conditions (71.8 %, p < 0.001). Among patients with surgical conditions, the difference between ultrasonography (US) and CT diagnoses was significant in groups 2 (p = 0.046) and 3 (p = .001). The impact of the change in diagnosis in surgical patients imaged with two modalities was significant in the group as a whole and in each age group separately. Non-diagnostic or equivocal US in a small percentage of patients is probably sufficient to justify the additional radiation burden.

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Section: Introductionmentioning

confidence: 97%

Diagnostic value of CT compared to ultrasound in the evaluation of acute abdominal pain in children younger than 10 years old

2015

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“…The appeal of this hypothesis is that it provides an explanation for certain epidemiological characteristics of appendicitis. The epidemiology of acute appendicitis shows a rising incidence accompanies increasing industrialisation (Barker et al, 1988). This is believed to be because as increasing industrialisation and improved socio-economic conditions arise there is a concomitant improvement in hygiene.…”

Section: The Pathophysiological Mechanisms Of Acute Appendicitismentioning

confidence: 99%

“…In the 2 to 5 age group, the pain tends to be more localised which is in contrast to the children of ages 2 and younger where the abdominal pain tends to be more diffuse. Localised tenderness has been reported to be present in less that 50% in this age group (Barker & Davey, 1988;Horwitz et al, 1997). Patients in this age group or even younger tend to also exhibit lethargy, abdominal distension, diarrhoea and fever.…”

Section: Appendicitis At the Extremes Of Agementioning

confidence: 99%

Diagnostic Challenges in Acute Appendicitis

Harrison¹,

Benziger²

2012

Appendicitis - A Collection of Essays From Around the World

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“…24 The high perforation rates in the series of Grosfeld and Barker (94% and 92%, respectively) could be related to the significant delay in diagnosis and appendectomy. 2,23 Conventional open appendectomy has generally been accepted as the immediate treatment for appendicitis. In perforated appendicitis, many institutions have adopted a more vigorous approach, consisting of immediate appendectomy, irrigation of peritoneal cavity, transperitoneal drainage through the wound and a 10-day course of intravenous antibiotics.…”

Section: 9-mentioning

confidence: 99%

“…Perforation rates in infants have been reported between 55% and 94% by several authors. 23,[9][10][11][12]23 Byrne et al showed that the duration of symptoms influenced the outcome of appendicitis.If symptoms were present from 0 to 11 hours, 13% of patients perforated, while 12 to 13 hours' duration produced a 23% perforation rate and if symptoms persisted for more than 72 hours, up to 100% perforated. 24 The high perforation rates in the series of Grosfeld and Barker (94% and 92%, respectively) could be related to the significant delay in diagnosis and appendectomy.…”

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confidence: 99%

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

Cherian

Egaily²,

Joseph³

2003

Ann Saudi Med

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Acute appendicitis is the most common pediatric surgical emergency, constituting 10% of all children admitted to the pediatric emergency department.1 However, appendicitis, in infants under 2 years of age is uncommon, constituting only 2% of all cases.2,3 Its incidence is much lower in neonates and young infants. Since the diagnosis is uncommon and hence unsuspected in this younger age group, treatment is often delayed and perforation is almost certain. Although the mortality rate has been significantly reduced by improvements in pre-operative fluid resuscitation, anesthetic and surgical techniques, post-operative care and the use of broad-spectrum antibiotics, late recognition has lead to increased post-operative morbidity and prolonged hospitalization. 4 We report a case of acute appendicitis and perforation in a 78-day old infant, who presented with fever, irritability and abdominal distension. Case ReportA 78-day old male infant presented to the emergency room (ER) with a history of fever, refusal of feeds, constipation, irritability and excessive crying for 24 hours. There was no vomiting. The infant was the product of an uneventful full-term pregnancy and cesarian delivery performed because of fetal distress and shoulder dystocia. The mother had premature rupture of membranes 15 days prior to delivery for which she received intravenous antibiotics. His birth weight was 1850 grams. A septic work up was negative and neonatal screening showed G6PD deficiency. When the patient was seen in the ER, his temperature was 39.2°C, heart rate was 160 per minute and respiratory rate was 34 per minute. He was irritable and crying, and hence examination was difficult.The abdomen was distended, but not rigid. Peristalsis was heard. No mass could be palpated and digital examination of the rectum was unremarkable. Urine examination was normal. His white cell count was 7.7 x 10 3 with 46% neutrophils. Blood chemistry as well CSF analysis was normal. Plain abdominal radiograph showed gasfilled small bowel loops in the central abdomen suggestive of ileus. There was no obvious wall or mucosal thickness nor any intraabdominal calcification. The infant was admitted for further management. Ultrasound examination of the abdomen waslimited due to significant abdominal distension and a large amount of bowel gases; however, no fluid collection or masses were found. Barium enema failed to show any gross abnormality of recto-sigmoid or appendix. There was no evidence of intussusception. A laparotomy was performed seven hours after admission. The appendix was found inflamed showing perforations at the tip as well as the base and the area of right lower quadrant was filled with a fibrinous material. The peritoneal cavity contained free purulent fluid. Appendectomy was performed followed by copious saline washing into all the four quadrants and insertion of Penrose drains. Postoperative CT scan of the abdomen ruled out any intra-peritoneal abscesses. Microscopic examination of the appendix revealed marked luminal dilatation with inspissate...

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Appendicitis in the First Three Years of Life

Cited by 31 publications

References 9 publications

Diagnostic value of CT compared to ultrasound in the evaluation of acute abdominal pain in children younger than 10 years old

Diagnostic value of CT compared to ultrasound in the evaluation of acute abdominal pain in children younger than 10 years old

Diagnostic Challenges in Acute Appendicitis

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

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