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Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

Index
Original Article
Clinical outcomes and pathologic results following identification of appendicitis
Aims: Acute appendicitis (AA) is one of the most frequent clinical pathologies for urgent surgery in children We aimed to investigate the occurrence and distribution of pathological findings in appendectomy specimens from patients initially diagnosed with AA.
Methods: The demographic information and histopathological findings of patients who underwent appendectomy at our center between 2011 and 2021 were retrospectively analyzed.
Results: A total of 259 patients were included in the study. The patients were aged 38-212 months (mean 143±39), with 180 (69.5%) male patients. Based on the histopathological results, 63 (24.3%) patienst had lymphoid hyperplasia (LH), 109 (42.1%) AA, 11 (4.2%) suppurative appendicitis (SA), 46 (17.8%) phlegmonous appendicitis (PA), and 30 (11.6%) gangrenous/necrotizing appendicitis (GA). Twenty (31.7%) patients with LH and 16 patients (53.3%) with GA had an invisible appendix on ultrasound. The leucocyte count and appendix diameter were significantly lower in LH than in the other groups (for all comparisons, p<0.001). CRP level was significantly higher in the complicated groups (GA, PA,SA) than the LH and AA groups. The appendix diameter was significantly higher in the GA group than in the PA group (p=0.049). We found a positive correlation between AD and preopertaive leucocyte count, and the duration of hospitalization in days (r=0.265, p=<0.001;r=0243, p=0.001). On the other hand, there was no correlation between appendix diameter and CRP. The binary logistic regression analyses showed that high appendix diameter was a risk factor fo CA (OR:0.206, CI: 95%, 1.061-1.422, p= 0.006).
Conclusion: The high rate of complicated cases (33.5%) we found in our study shows that appendicitis can still be complicated. Additionally, the conclusion has been drawn that even in serious cases such as GA, US may overlook appendicitis at a high rate. Finally new diagnostic methods should be developed for cases that do not require surgical intervention, such as LH and eosinophilic gastrointestinal pathologies (colitis).


1. Minneci PC, Mahida JB, Lodwick DL, et al. Effectiveness of patientchoice in nonoperative vs surgical management of pediatricuncomplicated acute appendicitis. JAMA Surg. 2016;151:408-415.
2. Klingler PJ, Seelig MH, DeVault KR, et al. Ingested foreign bodieswithin the appendix: a 100-year review of the literature. Digest Dis(Basel, Switzerland). 1998;16(5):308-314.
3. Carr NJ. The pathology of acute appendicitis. Annals Diagnost Pathol.2000;4(1):46-58.
4. Sugiura K, Miyake H, Nagai H, et al. Chronological changes inappendiceal pathology among patients who underwent appendectomyfor suspected acute appendicitis. World J Surg. 2020; 44(9):2965-2973
5. Fallon SC, Kim ME, Hallmark, CA et al. Correlating surgical andpathological diagnoses in pediatric appendicitis. J Pediatr Surg.2015;50(4):638-641.
6. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, ParisiMT. Revised ultrasound criteria for appendicitis in children improvediagnostic accuracy. Pediatr Radiol. 2011;41(8):993-999.
7. Wiersma F, Toorenvliet BR, Bloem JL, Allema JH, Holscher HC. USexamination of the appendix in children with suspected appendicitis:the additional value of secondary signs. Eur Radiol. 2009;19(2):455-461.
8. Harris J, Fleming CA, Stassen PN, et al. A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitisin paediatric and adult cohorts: an analysis of over 1000 patients. Irish JMed Sci. 2022;191(4):1809-1813.
9. Tannoury J, Abboud B. Treatment options of inflammatory appendicealmasses in adults. World J Gastroenterol.2013;19(25):3942-3950.
10. Kim DH, Lee JH, Kim D, Hwang S, Kang K, Koo JS. Acute SuppurativeAppendicitis Diagnosed by Acute Lower Gastrointestinal Hemorrhage.Korean J Gastroenterol. 2019:73(1):45-49.
11. Breeding E, Conran RM. Educational case: acute appendicitis. AcadPathol. 2020;7: 2374289520926640.
12. Marudanayagam R, Williams GT, Rees BI. Review of the pathologicalresults of 2660 appendicectomy specimens. J Gastroenterol.2006;41(8):745-749.
13. Swank HA, Eshuis EJ, Ubbink DT, Bemelman WA. Is routinehistopathological examination of appendectomy specimens useful? Asystematic review of the literature. Colorectal Dis. 2011; 13(11):1214-1221.
14. Khairy G. Acute appendicitis: is removal of a normal appendixstill existing and can we reduce its rate? Saudi J Gastroenterol.2009;15(3):167-170.
15. Seetahal SA, Bolorunduro OB, Sookdeo TC, et al. Negativeappendectomy: a 10-year review of a nationally representative sample.Am J Surg. 2011;201(4):433-437.
16. Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining acommon disease with unknown etiology: Trends in epidemiology andsurgical management of appendicitis in California, 1995e2009. World JSurg. 2012;36(12):2787-2794.
17. Grewal H, Sweat J, Vazquez WD. Laparoscopic appendectomy inchildren can be done as a fast-track or same-day surgery. JSLS.2004;8(2):151-154.
18. Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomyin adults with complicated appendicitis: systematic review and meta-analysis. World J Surg. 2010;34(9):2026-2040.
19. Brugger L, Rosella L, Candinas D, Guller U.Improving outcomes afterlaparoscopic appendectomy: a population-based, 12-year trend analysisof 7446 patients. Annals Surg. 2011; 253(2):309-313.
20. Daldal E, Dagmura H (2020) the correlation between complete bloodcount parameters and appendix diameter for the diagnosis of acuteappendicitis. Healthcare (Basel, Switzerland). 2020;8(1):39.
21. Abu-Yousef MM, Bleicher JJ, Maher JW, Urdaneta LF, Franken Jr E,Metcalf A. High-resolution sonography of acute appendicitis. Am JRoentgenol.1987;149(1):53-58.
22. Chen SC, Wang HP, Hsu HY, Huang PM, Lin FY. Accuracy of EDsonography in the diagnosis of acute appendicitis. Am J Emerg Med.2000;18(4):449-452.
23. Nikolaidis P, Hwang CM, Miller FH, Papanicolaou N. Thenonvisualized appendix: incidence of acute appendicitis whensecondary inflammatory changes are absent. AJR Am J Roentgenol.2004;183(4):889-892.
24. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology.2000;215(2):337-348.
25. Rao PM; Rhea JT; Novelline RA. Sensitivity and specificity ofthe individual CT signs of appendicitis: experience with 200helical appendiceal CT examinations. J Computer Assist Tomogr.1997;21(5):686-692.
26. Xu Y, Jeffrey RB, DiMaio MA, Olcott EW. Lymphoid hyperplasiaof the appendix: a potential pitfall in the sonographic diagnosis ofappendicitis. AJR. Am J Roentgenol. 2016; 206(1):189-194.
27. Collins DC. Acute retrocecal appendicitis: based on seven hundred andfifty-one instances. Arch Surg. 1938;36:729-743.
28. Wakely CPG. The position of the vermiform appendix as ascertained byan analysis of 10,000 cases. J Anat.1933;67:277-283.
29. Nance ML, Adamson WT, Hedrick HL. Appendicitis in the youngchild: a continuing diagnostic challenge. Pediatr Emerg Care.2000;16(3):160-162.
30. Howell EC, Dubina ED, Lee SL. Perforation risk in pediatricappendicitis: assessment and management. Pediatr Health, MedTherapeutics. 2018;9:135-145.
31. Yang F, Guo XC, Rao XL, Sun L, Xu L. Acute appendicitis complicatedby mesenteric vein thrombosis: a case report. World J Clin Cases.2021;9(36):11400-11405.
32. Rabah R. Pathology of the appendix in children: an institutionalexperience and review of the literature. Pediatr Radiol. 2007;37(1):15-20.
Volume 1, Issue 3, 2024
Page : 44-48
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