Comparison of Clinical Characteristics According to the Existence of Secondary appendicitis in Pediatric Acute Gastroenteritis: A Retrospective Single Center study

Abstract

Background In patients with acute gastroenteritis, radiologic findings are sometimes accompanied by secondary inflammation of the appendix. The purpose of this study was to evaluate the clinical features of acute gastroenteritis with secondary inflammation of the appendix. Methods Medical records from patients who underwent abdominal ultrasonography or computed tomography among those admitted for acute gastroenteritis at Haeundae Paik Hospital from June 2017 to May 2019 were retrospectively reviewed. Clinical features were compared by distinguishing patients with inflammation of the appendix from those without, based on their symptoms and laboratory findings. Results Of the 165 patients, 12 (7.3%) had secondary inflammation of the appendix on ultrasonography and/or computed tomography. Patients with secondary inflammation of the appendix were significantly older than those without (11.7 vs 6.1 years, p = 0.011) and more frequently had fever (83.3% vs 49.0%, p = 0.033), and high values of C-reactive protein (5.38 vs 0.32 mg/dl, p < 0.001). The proportion of viral pathogens was higher in patients without secondary appendicitis (0% vs 40.7%, p = 0.012), and the proportion of bacterial pathogens was higher in patients with secondary inflammation of the appendix (60% vs 15.1%, p = 0.004). Conclusions Patients with acute gastroenteritis accompanied by secondary appendicitis more commonly have fever, higher C-reactive protein levels, higher bacterial pathogen detection rates, and longer hospital stays. Treatment equivalent to that of bacterial infection is required for patients with secondary appendicitis, and that their symptoms should be closely and continuously monitored and followed-up.