Clinical Analysis Of Perforated Appendicitis In Children

Objective: Summary and analysis 1990-2009 clinical data on the pediatric appendicitis and discuss the related matter evidencing literature. It is profited to facilitate a comprehensive understanding of perforated appendicitis in children, handle feature of epidemiology, guidance diagnosis and treatment, it also can provide numerical data for deeply investigation.Methods: Continuous, non-selective collected clinical data of 10,256 cases of Appendicitis in children during the period 1980-2009. Design questionnaire for the clinical data of pediatric appendicitis in children. Only summary statistics of cases during the period 1980-1989, due to incomplete information. Summary the clinical data of 6607 cases of pediatric appendicitis in children on the 1990-2009 period in detail, include sex, age, hospitalization time, duration, length of stay, clinical symptoms, signs, body temperature, blood leukocyte and neutrophil counts, abdominal B-results, pathological classification, preoperative diagnosis, intraoperative appendix, postoperative diagnosis , peritoneal fluid situation, peritoneal washing, postoperative drainage situation, pus, postoperative complications and antibiotic use. Analysis the data of 1179 cases of perforated appendicitis in children on the 1990-2009 period.Results:1. In 6607 cases of pediatric patients with appendicitis, 4102 cases were male and 2505 cases were female. The ratio of male to female is 1.6:1. Perforated appendicitis were 1179 cases, accounting for 17.84% over the same period of appendicitis in children, 755 cases were male and 424 cases were female. The ratio of male to female is 1.78:1.2. 5770 cases of pathological results suggest that 1651 cases(28.61%) were simple appendicitis, 2752 cases(47.69%) were suppurative appendicitis, 1179 cases(20.43%) were gangrenous appendicitis, 188 cases (3.26%) were appendiceal abscess.3. The average age of 1179 cases of perforated appendicitis in children was 6.36 years. 286 cases(24.26%) were under 3 years which perforation rate was 32.32%; 368 cases(31.21%) were 4-6 years which perforation rate was 21.23%; 523 cases(44.36%) were 7-14 years which perforation rate was 13.22%; 2 cases(0.17%) were above 14 which perforation rate was 6.06%. Perforation rate among the various age groups were significantly different (P <0.01), 3 years of age were significantly higher than other age groups.4. The average visiting time of patients with perforated appendicitis was 44.03 hours(1 day 20 hours). 161 cases(13.65%) were course of 24 hours which perforation rate was 5.78%; 305 cases(25.87%) were course of 24-48 hours which perforation rate was 17.19%; 340 cases(28.84%) were course of 48-72 hours which perforation rate was 29.08% ; 373 cases (31.64%) were course of over 72 hours which perforation rate was 42.39%. The course of disease between the groups there were significant differences in perforation rate (P <0.01), 72 hours duration were significantly higher than other groups.5. There were abdominal pain in 1152 cases(97.71%), which 314 cases(26.63%) of right lower abdominal pain, 278 cases(23.58%) of metastatic right lower abdominal pain; 1148 cases(97.37%) of fever; 702 cases(59.54%) of nausea and vomiting; abdominal signs include: abdominal tenderness in 1152 cases(97.71%), which 800 cases(67.85%) of right lower quadrant tenderness; 317 cases(26.89%) of whole abdominal tenderness; blood leukocyte count in 985 cases(83.55%) was over 10×109/L, of which 225 cases (19.08%) was over 20×109/L; the proportion of neutrophils in 844 cases(71.59%) was over 0.8, of which 337 cases( 28.58%) was over 0.9.6. 545 cases of abdominal B-preoperative results were: right lower abdominal inflammation with non-liquid components in 240 cases(44.04%), right lower abdominal inflammation with the liquid components in 185 cases(33.95% ), abdominal (pelvic) fluid in 65 cases(11.93%), intestinal obstruction in 7 cases(1.28%), right lower abdominal with no significant inflammatory lesions in 48 cases(8.81%).7. 1179 cases underwent surgery, 490 cases of diffuse peritonitis, peritoneal lavage group and non-peritoneal lavage group, the average hospital stay was 8.03 days and 10.18 days. 38 cases of children with perforated appendicitis existed postoperative complications, the incidence rate was 3.22%, including 21 cases of pelvic abscess, 4 cases of abdominal abscess, 6 cases of intestinal adhesion and intestinal obstruction, 6 cases of wound infection, 1 case of ascites. 1 died.Conclusion: Acute perforated appendicitis is one of the complications after delayed treatment. Ruptured appendicitis is more common in children of school age, perforated appendicitis within 1 year of age is less common. In children of small age, a higher perforation rate shall be alert, early diagnosis and timely surgery is the key to reduce the incidence of perforated appendicitis in children. Currently ongoing fixed right lower abdominal pain and right lower quadrant tenderness of children with acute appendicitis in surgical indication effectively reduce the incidence of complications, use of antibiotics is an important factor in disease prognosis.