Fræðigrein

Introduction: Appendicitis is a common disease and can be life-threatening if not adequately treated. Studies have shown that if less than 20% of appendices removed are normal it indicates missing or delaying the diagnosis of appendicitis, resulting in an increased incidence of perforation. The purpose of this study was to analyze appendicitis in children during two separate time periods in the pediatric wards of the hospitals in Reykjavík and to increase our knowledge of appendicitis in children in the country.

Materials and methods: Patients entering this study are two groups of 100 children (?16 years) consecutively undergoing appendectomy in the Reykjavik hospitals, one group in 1996 and the other in 2006. Data on sex, age, clinical symptoms and treatment was obtained from patients records. The impression of the surgeon at time of operation on the inflammation of the removed appendix was compared with results of histopathology analysis. All histopathology slides from appendices from 2006 were re-evaluated. The parameters in open appendectomies were compared to those in laparoscopic appendectomies. The two study periods were compared.

Results: The proportion of normal appendices was similar in both periods of the study, 18% in 2006 and 20% in 1996. The appendices were more often normal in female patients (p<0.05) and the large majority of those were removed by laparoscopic surgery. Perforation was present in 17% of inflamed appendices in both study groups. The time from patients arrival to hospital until surgery surpassed 10 hours in only one case in each study group. A discrepancy between the surgeon´s assessment and the pathology result was noted only once in 2006 and in one additional case was the histopathological diagnosis altered following re-evaluation of the pathology slides.

Discussion: The proportion of non-inflamed appendices in appendectomies in children in Reykjavik is in accordance with that reported elsewhere and perforation is not common. There is a good concordance between surgical and pathological assessment with regard to inflammation of the appendices.

 

Figure 1. Histological diagnosis of appendices in children in 1996 and 2006.

Figure 2. Comparison of histological diagnosis of appendices by gender in the years 2006 and 1996. P-values indicate differences of normal appendices between genders within the study groups.

Figure 3. Time in hours from hospital admission to appendectomy in 2006 and 1996.

 

Tables:

Table I. Time in days from initiation of symptoms to admission to hospital and results on the inflammatory status of the appendix.

Table II. Appendicitis in children; time from arrival at the hospital until surgery in those patients with perforated appendicitis. (Cold removal indicates surgery following previous appendicitis)