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J Korean Soc Emerg Med > Volume 7(4); 1996 > Article
Journal of The Korean Society of Emergency Medicine 1996;7(4): 554-564.
A CLINICAL REVIEW OF ACUTE APPENDICITIS IN CHILDREN
Sung Tae Ahn, Yong Joo Lee, Seung Tae Han, Jun Sig Kim, Kyung Gook Kim
Department of Emergency Medicine, College of Medicine , lnha University, Korea
  Published online: December 31, 1996.
ABSTRACT
Acute appendicitis most commonly affects the young adult and the adolescent child. Although symptoms are generally recognized by pediatricians, general practicianers and emergency room physicians, young children and elderly patients are still often overlooked and misdiagnosed. It is true that acute appendicitis in infancy and childhood is very difficult to diagnose and has high incidence of perforation. This retrospective study was carried out on 184 consecutive patients fifteen years of age or younger who underwent operation because of suspicion of acute appendicitis at Inha hospital during the past three years between January 1, 1993 and December 31, 1995. The following results were obtained. There were 129 male (70.2%) and 55 female (29.9%) children. On operation 164 children (89.1%) had acute appendicitis, 20 (10.9°/o) had no disease in the appendix. Of the 164 children, 38 (23.2 %) had perforated appendixes. The highest incidence(31.1%) was in age group between ten and twelve years of age. The incidence was low(6.7%) under the age of 3. It occured most frequently in autumn, however it was not significant. The most common symptoms on initial presentation were abdominal pain, vomiting, nausea, fever, and anorexia in the order of frequency. The most common initial clinical signs were tenderness on right lower abdominal quadrant, rebound tenderness on right lower abdominal quadrant, and alxlominal rigidity in the order of frequency. The rate of perforation increased from 6.0% for children who had symptoms for less than 20 hours to 100% for those who had symptoms for longer than 80 hours. The rate of perforation was 22.6% for children who had mean duration (time from patient hospital arrival to operation) less than 6 hours. Leukocytosis (more than 10,000 cells/mm3) was present in 138 children (84.1%) with an average white blood cell count of 14,200 cells/mm3 and with perforation rate 24.6%. The average hospital stay after operation was 5.7 days. The rates of perforation were 14.3% for children who had admitted via emergency department, 46.7% for children who had admitted via any pediatric or general surgery outpatient department, 92.3% for children who had admitted via pediatric outpatient department, 28.1% for children who had admitted via general surgery outpatient department.
Key words: Acute appendicitis, Children
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