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, Gudiño-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.	中华医学会小儿外科分会内镜外科学组. 腹腔镜小儿阑尾切除术操作指南 (2017 版). 中华小儿外科杂志, 2017, 38(10): 725-732.
5.	周诗琼, 梅红, 段栩飞, 等. 小儿慢性阑尾炎的临床特点分析. 临床外科杂志, 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.	范晓娟, 刘广禄, 张宝娟. 超声检查对儿童急慢性阑尾炎的诊断价值. 安徽医药, 2018, 22(7): 1312-1314.
12.	李怡红, 冯秋生, 丁毅, 等. 高频超声在慢性阑尾炎诊断中的应用价值. 中国煤炭工业医学杂志, 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, 黄瑛, 富聪聪, 等. 超声与 CT 诊断小儿急慢性阑尾炎的对比分析. 中国临床医学影像杂志, 2014, 25(11): 793-796.
15.	谭平, 孙晓蓉. 钡餐造影 72 h 后复查对诊断慢性阑尾炎的临床价值分析. 中国辐射卫生, 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, 刘凡, 叶颖江, 等. 腹腔镜阑尾切除术在急性和慢性阑尾炎中应用疗效的比较. 中华普通外科杂志, 2013, 28(2): 93-95.
22.	谈波, 张英民. 急性和慢性阑尾炎患者的微创手术疗效比较. 中华普外科手术学杂志 (电子版), 2015, 9(1): 72.
23.	叶春. 腹腔镜阑尾切除术 40 例治疗体会. 中国普外基础与临床杂志, 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, Gudiño-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. 中华医学会小儿外科分会内镜外科学组. 腹腔镜小儿阑尾切除术操作指南 (2017 版). 中华小儿外科杂志, 2017, 38(10): 725-732.
5. 周诗琼, 梅红, 段栩飞, 等. 小儿慢性阑尾炎的临床特点分析. 临床外科杂志, 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. 范晓娟, 刘广禄, 张宝娟. 超声检查对儿童急慢性阑尾炎的诊断价值. 安徽医药, 2018, 22(7): 1312-1314.
12. 李怡红, 冯秋生, 丁毅, 等. 高频超声在慢性阑尾炎诊断中的应用价值. 中国煤炭工业医学杂志, 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, 黄瑛, 富聪聪, 等. 超声与 CT 诊断小儿急慢性阑尾炎的对比分析. 中国临床医学影像杂志, 2014, 25(11): 793-796.
15. 谭平, 孙晓蓉. 钡餐造影 72 h 后复查对诊断慢性阑尾炎的临床价值分析. 中国辐射卫生, 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, 刘凡, 叶颖江, 等. 腹腔镜阑尾切除术在急性和慢性阑尾炎中应用疗效的比较. 中华普通外科杂志, 2013, 28(2): 93-95.
22. 谈波, 张英民. 急性和慢性阑尾炎患者的微创手术疗效比较. 中华普外科手术学杂志 (电子版), 2015, 9(1): 72.
23. 叶春. 腹腔镜阑尾切除术 40 例治疗体会. 中国普外基础与临床杂志, 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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