Clinical characteristics and treatment experience of 68 children with chronic appendicitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Yue ¹ , HUANG Ran ¹ , WU Wenyong ² , LI Weisong ¹

1. Department of Pediatric Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, P. R. China;
2. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, P. R. China;

Corresponding?author：

WANG Yue, Email: ahmuwangyue@163.com

Keywords：

chronic appendicitis; pediatric; characteristics; treatment

DOI：

10.7507/1007-9424.202004095

Video：

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Objective To summarizes the clinical characteristics of chronic appendicitis in children and discusses the diagnostic methods and the clinical application value of laparoscopic surgery.Methods The clinical data and treatment process of 68 children with chronic appendicitis admitted to the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2020 were retrospectively analyzed, and their clinical characteristics and treatment experience were summarized and analyzed.Results According to different medical histories and symptoms, 68 cases were divided into 3 groups, with 15 patients in the typical symptom group, 28 patients in the appendix abscess group, and 25 patients in the asymptomatic group. All the 25 children in the asymptomatic group underwent barium enema examination, among which 68.0% (17/25) had filling defect in the appendix cavity, 16.0% (4/25) had no obvious appendix visualization, and 68.0% (17/25) had residual barium in the appendix cavity after 72 hours. The incidence of children in the 3 groups was concentrated at school age, but there was no significant difference in the proportion of children in different age groups between the three groups (P>0.05). All cases underwent laparoscopic exploration, 66 cases successfully completed laparoscopic appendectomy, 2 cases transferred to laparotomy, and all recovered satisfactorily. There was no statistically significant difference in the incidence of postoperative complications between the 3 groups (P>0.05).Conclusions The clinical manifestations of chronic appendicitis in children are diverse and difficult to diagnose. Barium enema examination (including re-examination after 72 hours) in children with atypical symptoms can help confirm the diagnosis. Chronic appendicitis in children is more common in school-age children, and laparoscopic exploration+appendectomy are the preferred treatment.

Citation： WANG Yue, HUANG Ran, WU Wenyong, LI Weisong. Clinical characteristics and treatment experience of 68 children with chronic appendicitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1491-1495. doi: 10.7507/1007-9424.202004095 Copy

1.	Coccolini F, Fugazzola P, Sartelli M, et al. Conservative treatment of acute appendicitis. Acta Biomed, 2018, 89(9-S): 119-134.
2.	Zubieta-O'Farrill G, Guerra-Mora JR, Gudi?o-Chávez A, et al. Appendiceal diverticulum associated with chronic appendicitis. Int J Surg Case Rep, 2014, 5(12): 961-963.
3.	Kim D, Butterworth SA. Chronic appendicitis in children. Can Fam Physician, 2016, 62(6): e304-e305.
4.	中華醫學會小兒外科分會內鏡外科學組. 腹腔鏡小兒闌尾切除術操作指南 (2017 版). 中華小兒外科雜志, 2017, 38(10): 725-732.
5.	周詩瓊, 梅紅, 段栩飛, 等. 小兒慢性闌尾炎的臨床特點分析. 臨床外科雜志, 2015, 23(8): 621-623.
6.	Sazhin AV, Mosin SV, Kodzhoglian AA, et al. Principles of diagnostics and treatment of chronic appendicitis. Khirurgiia (Mosk), 2011, 5: 32-38.
7.	Crymble PT, Forsythe I. Chronic appendicitis in children. Ulster Med J, 1949, 18(2): 153-172.
8.	Sierakowski K, Pattichis A, Russell P. Unusual presentation of a familiar pathology: chronic appendicitis. BMJ Case Rep, 2016, 2016: bcr2015212485.
9.	Stroh C, Rauch J, Schramm H. Is there a chronic appendicitis in childhood? Analysis of pediatric surgical patients from 1993-1997. Zentralbl Chir, 1999, 124(12): 1098-1102.
10.	Whorwell PJ. The continuing dilemma of chronic appendicitis. Therap Adv Gastroenterol, 2015, 8(3): 112-113.
11.	范曉娟, 劉廣祿, 張寶娟. 超聲檢查對兒童急慢性闌尾炎的診斷價值. 安徽醫藥, 2018, 22(7): 1312-1314.
12.	李怡紅, 馮秋生, 丁毅, 等. 高頻超聲在慢性闌尾炎診斷中的應用價值. 中國煤炭工業醫學雜志, 2017, 20(8): 928-930.
13.	Shah SS, Gaffney RR, Dykes TM, et al. Chronic appendicitis: an often forgotten cause of recurrent abdominal pain. Am J Med, 2013, 126(1): e7-e8.
14.	夏禹, 黃瑛, 富聰聰, 等. 超聲與 CT 診斷小兒急慢性闌尾炎的對比分析. 中國臨床醫學影像雜志, 2014, 25(11): 793-796.
15.	譚平, 孫曉蓉. 鋇餐造影 72 h 后復查對診斷慢性闌尾炎的臨床價值分析. 中國輻射衛生, 2017, 26(1): 108-110.
16.	Decou JM, Gauderer MW, Boyle JT, et al. Diagnostic laparoscopy with planned appendectomy: an integral step in the evaluation of unexplained right lower quadrant pain. Pediatr Surg Int, 2004, 20(2): 123-126.
17.	Stringel G, Berezin SH, Bostwick HE, et al. Laparoscopy in the management of children with chronic recurrent abdominal pain. JSLS, 1999, 3(3): 215-219.
18.	Moore MM, Gustas CN, Choudhary AK, et al. MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol, 2012, 42(9): 1056-1063.
19.	Husain M, Sachan PK, Khan S, et al. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Trop Gastroenterol, 2013, 34(3): 170-173.
20.	Zhao J, Samaan JS, Toubat O, et al. Laparoscopy as a diagnostic and therapeutic modality for chronic abdominal pain of unknown etiology: a literature review. J Surg Res, 2020, 252: 222-230.
21.	王有利, 劉凡, 葉穎江, 等. 腹腔鏡闌尾切除術在急性和慢性闌尾炎中應用療效的比較. 中華普通外科雜志, 2013, 28(2): 93-95.
22.	談波, 張英民. 急性和慢性闌尾炎患者的微創手術療效比較. 中華普外科手術學雜志 (電子版), 2015, 9(1): 72.
23.	葉春. 腹腔鏡闌尾切除術 40 例治療體會. 中國普外基礎與臨床雜志, 2012, 19(5): 521.
24.	Shen Z, Ye Y, Yin M, et al. Laparoscopic appendectomy for acute appendicitis versus chronic appendicitis. J Invest Surg, 2012, 25(4): 209-213.
25.	Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therap Adv Gastroenterol, 2015, 8(3): 160-162.

1. Coccolini F, Fugazzola P, Sartelli M, et al. Conservative treatment of acute appendicitis. Acta Biomed, 2018, 89(9-S): 119-134.
2. Zubieta-O'Farrill G, Guerra-Mora JR, Gudi?o-Chávez A, et al. Appendiceal diverticulum associated with chronic appendicitis. Int J Surg Case Rep, 2014, 5(12): 961-963.
3. Kim D, Butterworth SA. Chronic appendicitis in children. Can Fam Physician, 2016, 62(6): e304-e305.
4. 中華醫學會小兒外科分會內鏡外科學組. 腹腔鏡小兒闌尾切除術操作指南 (2017 版). 中華小兒外科雜志, 2017, 38(10): 725-732.
5. 周詩瓊, 梅紅, 段栩飛, 等. 小兒慢性闌尾炎的臨床特點分析. 臨床外科雜志, 2015, 23(8): 621-623.
6. Sazhin AV, Mosin SV, Kodzhoglian AA, et al. Principles of diagnostics and treatment of chronic appendicitis. Khirurgiia (Mosk), 2011, 5: 32-38.
7. Crymble PT, Forsythe I. Chronic appendicitis in children. Ulster Med J, 1949, 18(2): 153-172.
8. Sierakowski K, Pattichis A, Russell P. Unusual presentation of a familiar pathology: chronic appendicitis. BMJ Case Rep, 2016, 2016: bcr2015212485.
9. Stroh C, Rauch J, Schramm H. Is there a chronic appendicitis in childhood? Analysis of pediatric surgical patients from 1993-1997. Zentralbl Chir, 1999, 124(12): 1098-1102.
10. Whorwell PJ. The continuing dilemma of chronic appendicitis. Therap Adv Gastroenterol, 2015, 8(3): 112-113.
11. 范曉娟, 劉廣祿, 張寶娟. 超聲檢查對兒童急慢性闌尾炎的診斷價值. 安徽醫藥, 2018, 22(7): 1312-1314.
12. 李怡紅, 馮秋生, 丁毅, 等. 高頻超聲在慢性闌尾炎診斷中的應用價值. 中國煤炭工業醫學雜志, 2017, 20(8): 928-930.
13. Shah SS, Gaffney RR, Dykes TM, et al. Chronic appendicitis: an often forgotten cause of recurrent abdominal pain. Am J Med, 2013, 126(1): e7-e8.
14. 夏禹, 黃瑛, 富聰聰, 等. 超聲與 CT 診斷小兒急慢性闌尾炎的對比分析. 中國臨床醫學影像雜志, 2014, 25(11): 793-796.
15. 譚平, 孫曉蓉. 鋇餐造影 72 h 后復查對診斷慢性闌尾炎的臨床價值分析. 中國輻射衛生, 2017, 26(1): 108-110.
16. Decou JM, Gauderer MW, Boyle JT, et al. Diagnostic laparoscopy with planned appendectomy: an integral step in the evaluation of unexplained right lower quadrant pain. Pediatr Surg Int, 2004, 20(2): 123-126.
17. Stringel G, Berezin SH, Bostwick HE, et al. Laparoscopy in the management of children with chronic recurrent abdominal pain. JSLS, 1999, 3(3): 215-219.
18. Moore MM, Gustas CN, Choudhary AK, et al. MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol, 2012, 42(9): 1056-1063.
19. Husain M, Sachan PK, Khan S, et al. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Trop Gastroenterol, 2013, 34(3): 170-173.
20. Zhao J, Samaan JS, Toubat O, et al. Laparoscopy as a diagnostic and therapeutic modality for chronic abdominal pain of unknown etiology: a literature review. J Surg Res, 2020, 252: 222-230.
21. 王有利, 劉凡, 葉穎江, 等. 腹腔鏡闌尾切除術在急性和慢性闌尾炎中應用療效的比較. 中華普通外科雜志, 2013, 28(2): 93-95.
22. 談波, 張英民. 急性和慢性闌尾炎患者的微創手術療效比較. 中華普外科手術學雜志 (電子版), 2015, 9(1): 72.
23. 葉春. 腹腔鏡闌尾切除術 40 例治療體會. 中國普外基礎與臨床雜志, 2012, 19(5): 521.
24. Shen Z, Ye Y, Yin M, et al. Laparoscopic appendectomy for acute appendicitis versus chronic appendicitis. J Invest Surg, 2012, 25(4): 209-213.
25. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therap Adv Gastroenterol, 2015, 8(3): 160-162.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical characteristics and treatment experience of 68 children with chronic appendicitis

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