Acute Appendicitis in Children; Correlation of Clinical Data with Histopathological Findings

.. Objective: The study was conducted to identify clinical features significantly associated with histopathologically proven appendicitis in children. Design: Cross-Sectional Observational. Place and Duration of study: This study was conducted in Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Patients and methods: Children aged 2 to 14 years who underwent appendectomy for acute appendicitis during the study period were included. Patients who had appendectomy for any reason other than appendicitis were excluded. Presenting symptoms, signs, hospital course of patients and histopathological diagnosis were recoded. Data was analyzed by using SPSS. Sensitivity, specificity, positive predictive value and negative predictive value for each symptom and sign were calculated. Results: Out of 1420 patients who were evaluated during the study period for acute abdominal pain, 70(5%) were diagnosed with acute appendicitis. Four patients left against medical advice so 66 patients were studied. Patients were divided into acute appendicitis and non-inflamed appendix group on the basis of histopathology of resected appendix. Acute appendicitis was confirmed histologically in 43 (65%) cases and perforated appendicitis was found in 8 (12%). No evidence of acute inflammation was found in 15 (22%) cases. Among clinical features only involuntary guard (p-value 0.01) and rebound tenderness (p-value 0.004) were significantly different among acute appendicitis and non-inflamed appendix group. Total leukocyte count more than 11,000 was significantly higher in acute appendicitis group. Conclusions: The cornerstone of diagnosis of acute appendicitis in children is thorough history and meticulous physical examination. Involuntary guard, rebound tenderness and total leukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases of appendicitis.