Experience of a regional Center in Treating Acute Appendicitis in Children

Introduction. The aim of this study is to evaluate the effectiveness of laboratory indices of inflammatory response in predicting the development of acute appendicitis in children.

Materials and methods. Data on 300 pediatric patients who underwent appendectomy for acute appendicitis at the surgical department of the State Healthcare Institution "Ulyanovsk Regional Children's Clinical Hospital" in Ulyanovsk were retrospectively analyzed for the period from September 1, 2023, to June 1, 2024.

Results. Upon analyzing the results, it was revealed that phlegmonous appendicitis (145 cases) occurs statistically significantly more often in the age group of 6–12 years (𝑝=0,048). Univariate statistical analysis showed that the statistically significant parameters depending on the type of acute appendicitis are vomiting (𝑝 <0,001) and the time interval from the onset of the disease (appearance of the first symptoms) to the performance of surgical intervention (𝑝<0,001). Univariate statistical analysis of instrumental-laboratory parameters yielded the following statistically significant indicators of acute appendicitis development: Ultrasound signs of inflammation of the vermiform appendix (𝑝<0,001), Garkavi index (𝑝<0,001), LII (Leukocyte intoxication index) (𝑝<0,001), NLI (Neutrophil-lymphocyte index) (𝑝<0,001), and TLI (Thrombocyte-lymphocyte index) (𝑝<0,001).

Conclusion. Among pediatric patients, acute appendicitis most commonly occurs in the age group of 6–12 years and is diagnosed as phlegmonous appendicitis. Significant indicators that allow determining the development of acute appendicitis and the nature of its course include: NLI, TLI, LII, Garkavi index, and the results of ultrasound examination of the vermiform appendix. The comprehensive use of these indicators in the diagnosis of acute appendicitis will allow for the timely diagnosis of the condition.

1. Surgical care in the Russian Federation. Information and analytical collection for 2022. https://anyflip.com/nvzse/vipw/ (Дата обращения: 23.05.2024). (In Russ.)

2. Almaramhy H. H. Acute appendicitis in young children less than 5 years: review article. Italian journal of pediatrics, 2017, № 43(1), рр. 15. https://doi.org/10.1186/s13052-017-0335-2

3. Glass C. C., & Rangel S. J. Overview and diagnosis of acute appendicitis in children. Seminars in pediatric surgery, 2016, № 25(4), рр. 198–203. https://doi.org/10.1053/j.sempedsurg.2016.05.001

4. Haijanen J., Sippola S., Tuominen R., Grönroos J., Paajanen H., Rautio T., Nordström P., Aarnio M., Rantanen T., Hurme S., & Salminen P. Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PloS one, 2019, № 14(7), рр. e0220202. https://doi.org/10.1371/journal.pone.0220202

5. Ostrovsky V.K., Svitich Yu.M., WeberV.R. Leukocyte indexofintoxication in acute purulent and inflammatory lung diseases. Grekov’s Bulletin of Surgery, 1983, № 131(11), рр. 21–24. (In Russ.)

6. Garkavi L. Kh., Kvakina E. B., Ukolova M. A. Adaptive reactions and body resistance. Rostov-on-Don, Rostov University Publishing House, 1990, № 223. (In Russ.).

7. Mekitarian Filho E., Horita S. M., Dos Santos C. O. G., Pelosi C. S., Laurentino L. P., & Galotti B. L. Management of Acute Appendicitis in Children in a University Hospital. Pediatric emergency care, 2023, № 39(11), рр. 832–835. https://doi.org/10.1097/PEC.0000000000003059

8. Téoule P., Laffolie J., Rolle U., & Reissfelder C. Acute Appendicitis in Childhood and Adulthood. Deutsches Arzteblatt international, 2020, № 117(45), рр. 764–774. https://doi.org/10.3238/arztebl.2020.0764

9. Sokolov S.V., Morozov E.V., Anfinogenov A.L., Shchedrov D.N., Bunin I.V., Andreev A.I., Lobanova A.N. Development of complicated forms of acute appendicitis in children of different ages. Russian bulletin of pediatric surgery, anesthesiology and resuscitation, 2020, № S. (In Russ.)

10. Soundappan S. S., Karpelowsky J., Lam A., Lam L., & Cass D. Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children. Journal of pediatric surgery, 2018, № 53(10), рр. 2023–2027. https://doi.org/10.1016/j.jpedsurg.2018.05.014

11. Nijssen D. J., van Amstel P., van Schuppen J., Eeftinck Schattenkerk L. D., Gorter R. R., & Bakx R. Accuracy of ultrasonography for differentiating between simple and complex appendicitis in children. Pediatric surgery international, 2021, № 37(7), рр. 843–849. https://doi.org/10.1007/s00383-021-04872-8

12. Virmani S., Prabhu P. S., Sundeep P. T., & Kumar V. Role of laboratory markers in predicting severity of acute appendicitis. African journal of paediatric surgery: AJPS, 2018, № 15(1), рр. 1–4. https://doi.org/10.4103/ajps.AJPS_47_16

13. Hodge S. V., Mickiewicz B., Lau M., Jenne C. N., & Thompson G. C. Novel molecular biomarkers and diagnosis of acute appendicitis in children. Biomarkers in medicine, 2021, № 15(12), рр. 1055–1065. https://doi.org/10.2217/bmm-2021-0108

14. Dooki M. E., Nezhadan M., Mehrabani S., Osia S., Hadipoor A., Hajiahmadi M., & Mohammadi M. Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children. Diagnostische Genauigkeit von Labormarkern für die Diagnose einer akuten Appendizitis bei Kindern. Wiener medizinische Wochenschrift (1946), 2022, № 172(13–14), рр. 303–307. https://doi.org/10.1007/s10354-021-00898-8

15. Gromov M.I., Rysev A.V., Zhuravlev Yu.F., Pivovarova L.P., Ariskina O.B., Markelova E.V. Leukocyte index of intoxication according to V. K. Ostrovskii as a criterion for assessing bacterial infection. Grekov’s Bulletin of Surgery, 2023, № 182(2), рр. 53–58. (In Russ.) https://doi.org/10.24884/0042-4625-2023-182-2-53-58