PATTERN OF PRESENTATION AND OUTCOME OF PEDIATRIC APPENDICITIS: A REGIONAL HOSPITAL EXPERIENCE
Akhigbe T, Adeyanju A, Nasir A, Smith F, Condon E, Waldron D
Department of Surgery, Midwestern Regional Hospital Limerick, Ireland.
Abstract

Background
Acute appendicitis in children is a common presentation and it diagnosis is majorly clinical; evaluating the pattern of presentation can be challenging especially dealing with a child with abdominal pain. This study evaluates our experience on the pattern of presentation and outcome of appendicitis in children.

Methods
This is a descriptive study that involves retrospective review of 218 paediatric cases from January 2006 to November 2009 in Midwestern Regional Hospital Limerick, Ireland. Patient age ranged 2 to 14 years. Signs, symptoms, investigation, surgery, histology findings, post operative length of stay, complication and histology report were analysed to determine the pattern and outcome.

Results
Out of 218 patients, 130 were males and 88 females with age range from 2 to 14 years, 175(79.4%) had pain on their right lower quadrant and 45(20.6%) had the classical periumbilical pain that radiated to the right iliac fossa along with 33(15.4%) patients that had anorexia. Eleven patients (5.1%) presented with diarrhea while 7(3.7%) had constipation. Raised white cell count was seen in 146(67%) of the patients. Open appendectomy was done in 162(74.3%) patients, whereas 52(24%) had laparoscopic appendectomy including conversion rate of 7.7% (4 conversions). Histology finding of normal appendix was 27(12.4%), perforated and gangrenous appendix was found in 12(5.6%) and 10(4.3%) patients respectively. Wound infection occurred in 17 cases (7.8%) with 4(1.8%) and 2 (0.9%) cases of intra-abdominal and pelvic abscess respectively. The average post operative length of stay was 3 days except for complicated cases that were more than 5 days.

Conclusions
Pediatric appendicitis is a common surgical emergency that require prompt diagnosis majorly based on clinical presentations. Wound infection and dehiscence are common complications and laparoscopic appendectomy is safe.
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