Evaluation of the Pediatric Acute Appendicitis

Evaluation of the Pediatric Acute Appendicitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Pediatric Acute Appendicitis Omar Ajaj This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8627797/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: We evaluated the demographic characteristics, clinical presentation, diagnostic clues, morbidity, and the final outcomes of acute appendicitis in kids. Methodology: All kids up to 14 years who were diagnosed and operated for acute appendicitis were included in the study. The diagnosis of acute appendicitis was established by clinical findings, laboratory tests and ultrasound findings, finally was confirmed by macroscopic inspection during surgery, and combined with the histopathological analysis. Results: Over a period of study (24 months), out of 98 kids, 61% were males and 39% were females. We observed 56% kids developed acute appendicitis at the age of (10-12) years. In this study, the common signs and symptoms at presentation are nausea/ vomiting (98%), anorexia (91%), right lower abdominal tenderness (78%), and vague abdominal pain (71%). Elevated WBC count (85%), Neutrophilia (84%), and urine ketones (78%) are the most common biomarkers related to pediatrics acute appendicitis. Positive ultrasound finding for appendicitis in n=57(58%). Prevalence of appendicoliths was 86.7%. Unnecessary appendicectomy rate was 8%. The most common morbidities are wound infection 53%, adhesive bowel obstruction= 21%, postoperative abdominal abscess= 14%, and wound dehiscence =12%. Conclusion: Vague abdominal pain, nausea, vomiting, and anorexia are the most frequent presenting clinical findings of acute appendicitis in kids. Right lower quadrant tenderness is the most important clinical parameter in diagnosis of kids with acute appendicitis. Elevated WBC count, neutrophilia, and urine ketones are the most supportive biomarkers related to pediatrics acute appendicitis. The most postoperative morbidities are the wound infection, adhesive bowel obstruction, postoperative abdominal abscess, and wound dehiscence. appendicitis pain appendectomy and perforation Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Acute appendicitis is the most commonly emergency etiology requires abdominal surgery in kids. Diagnosis of appendicitis may remain problematic, particularly in younger kids [ 1 ]. Delay diagnosis and intervention of appendicitis can be leading to complications such as mass, abscess, appendix perforation, peritonitis, small bowel obstruction, sepsis, and enterocutaneous fistula [ 2 ]. In one-third of children with appendicitis, the appendix ruptures prior to operative treatment. In early kids greater omentum is underdeveloped, therefore it does not localize the infection, and higher rate of perforation (23–73) %, diffuse peritonitis can be developing. Because difficulties in communication and examination, there are several studies reporting challenging in diagnosis of children appendicitis, this will lead to higher rate of both negative appendectomies and delayed diagnosis [ 3 ]. Diagnosis of acute appendicitis is requiring combination of clinical information, biomarkers, and radiological imaging. However, unnecessary surgical intervention should be avoided, delayed diagnosis and management of acute appendicitis leads to higher rate of perforation, peritonitis, wound infection, intraabdominal abscess collection, and late adhesive intestinal obstruction [ 4 ]. Methodology This is a retrospective study conducted in pediatric surgery department, between February 2023 to January 2025. It included 98 children presented with acute appendicitis for two years. All kids up to 14 years who were diagnosed and operated for acute appendicitis were included in the study. Those children who had chronic appendicitis were excluded from the study. The diagnosis of acute appendicitis was established by clinical findings, laboratory tests and ultrasound findings, finally was confirmed by macroscopic inspection during surgery, and combined with the histopathological analysis. Data was entered and analyzed using Microsoft Excel 2010. Elevated WBC was indicated for WBC more than 12.000 cells/mL. Positive ultrasound was indicated for appendicular thickness more than 2mm, diameter more than 6mm, non-compressible a peristaltic tubular structure at right iliac fossa, and appendicular mass or abscess. Data was collected from child pertaining to age, sex, duration of presentation, clinical findings and other laboratory. ultrasonography (USG) was performed in all kids. Results Over a period of study (24 months), 98 kids aged up to 14 years with a diagnosis of acute appendicitis were reviewed. Demographic characteristics of children with acute appendicitis. Out of 98 kids, 60(61%) were males and 38(39%) were females. We observed 55(56%) kids developed acute appendicitis at the age of (10–12) years and the rest 31(32%) presented after the age of 12 years, and 12(12%) of kids at less than 10 years of age. Most of cases were presented in 24–48 hrs.(figure.1) Table (1): Clinical features of children with acute appendicitis : Finding N % Migrating pain 28 29 Vague abdominal pain 70 71 Fever after pain 40 41 Nausea/ vomiting 96 98 Anorexia 89 91 Diarrhea 19 19 RLQ Tenderness 76 78 Diffuse abdominal tenderness 22 22 Table (2): Laboratory and ultrasound finding. Categories Number % Elevated WBC count 83 85 Neutrophilia 82 84 Positive ultrasound finding 57 58 Elevated CRP 19 19 Urine ketones 76 78 Table (3): Location of fecolith in our study. Categories Number % Fecolith at base of appendix 31 32 Fecolith at tip of appendix 9 9 No fecolitth 13 13 Fecolith at mid of appendix 45 46 The final outcome was including 62% of perforated appendicitis, 30% of non- perforated suppurative appendicitis(figure.2). our postoperative morbidity rates are (figure.3), the wound infection rate was 53%(n = 26), adhesive bowel obstruction = 21%(n = 10), postoperative abdominal abscess = 14%(n = 7), and wound dehiscence = 12%(n = 6). Discussion Clinical presentation of acute appendicitis in kids are mostly similar with other frequent abdominal pathology, therefore, this may lead to difficulty in diagnosis. In the present study, 60(61%) were males and 38(39%) were females, and was consistent with the results of most literatures, boys outnumbered girls. We observed most of kids 55(56%) developed acute appendicitis at the age of (10–12) years and the rest 31(32%) presented after the age of 12 years, and 12(12%) of kids at less than 10 years of age. This result is comparable with A. H. Shera et.al.[ 5 ] who found that (45.6%) fall in the age10–12 years, and by Richard J et al. [ 5 ] who found that mean age of clinical presentation was in the age 11–12 years. This study showed that durations of symptoms are (45%)within 1–2 days after symptoms onset, (31%) after 3 days, and (24%) in the 1st day. Recent reports have shown that delayed presentation in the developing world as > 80% of kids have more history (> 24hours) of a prior visit to emergency department. The diagnostic delay in our study may be due to the children referred after been treated early in nurse clinics for several days or by pediatrician that depend on imaging studies to exclude acute appendicitis in treating kids who developed abdominal pain and other GIT symptoms, this will lead to misdiagnose acute appendicitis as gastroenteritis in early stage [ 2 ]. In this study, the common signs and symptoms at presentation are nausea/ vomiting (98%), anorexia (91%), right lower abdominal tenderness (78%), and vague abdominal pain (71%). the sensitivity of clinical parameters alone in diagnosis of kids with acute appendicitis between were (54–70) % into (70–87) % in adults [ 4 ]. Multiple studies have been published that pain migrating to the right lower quadrant, right lower quadrant tenderness, vomiting, fever, and nausea were very often concomitant clinical parameters that improve diagnostic accuracy of appendicitis [ 6 ]. Recent reports have shown that higher WBC, and neutrophil count have been used to support prediction of (diagnosis) appendicitis. In our series, elevated WBC count (85%), Neutrophilia (84%), and urine ketones (78%) are the most common biomarkers related to pediatrics acute appendicitis, this result is constant with multiple studies that found elevated WBC count, and neutrophilia have significantly higher odds for acute appendicitis [ 7 ]. On the other hand, the specificity for elevated CRP (19%) was lowest and does not support prediction of (diagnosis) pediatrics appendicitis, this result is constant to E. Kim et al. [ 8 ] who found that high CRP does not help in diagnosing pediatrics appendicitis. In our series, positive ultrasound finding for appendicitis in n = 57(58%). Diagnosis of pediatrics acute appendicitis is based primarily on clinical examination, no specific diagnostic tool for pediatrics appendicitis. Some report said that use of CT and US scan may improve the accuracy of the diagnosis of pediatrics appendicitis [ 9 ]. Others series found that the imaged studies did not have improvement in diagnostic accuracy/outcome when compared to clinical examination by an experienced pediatric surgeon. There are several limitations, and disadvantages of imaging modality: use of abdominal ultrasound scan not always available, and operative dependent. In addition to application of CT scanning must be with caution in kids because of risk of use contrast material and the radiation [ 10 ]. In our study, the prevalence of appendicoliths was 86.7% (85/98), in Lowe et al. [ 11 ] the prevalence of appendicoliths was 65%, while in Abeş et al. [ 11 ] studies the prevalence was 46% and 54.6% in H. M. Yoon, et. al. [ 12 ] the difference of prevalence of appendicoliths may be related to the difference in the diet pattern (The positive correlation between low-fiber diet with appendicoliths appendicitis). In the present series, the location of fecolith (32%) at base of appendix, (46%) at mid of appendix, (9%) at tip of appendix, (12%) no fecolitth. In other series the location of fecolith (32%) at base of appendix, (39%) at mid of appendix, (28%) at tip of appendix, (1%) no fecolitth [13]. In our study, the final outcome was confirmed by surgical and histopathological analysis which includes 62% of perforated appendicitis, 30% of non- perforated suppurative appendicitis. Multiple studies found that the perforation rate in pediatrics was 19% and is ranging from (30–45) % [ 5 ]. Unlike previous reports, our study had high rate of perforated appendicitis (62%), this result was supported by Afuwape, et al . [ 6 ] who studied 313 of pediatrics acute appendicitis and found that rate of perforated appendix was 50%. High rate of Perforation could be due to high prevalence appendicoliths appendicitis is associated with appendiceal perforation, and delay in presentation. In our series, the unnecessary appendicectomy rate was 8%, other studies were observed rate of unnecessary appendicectomies in 16 out of 126(13%) children. In addition, Cesare, et al. [ 9 ] found that negative appendectomy rate 8.8%. Lee and Ho et. al. [ 4 ] found that rate of unnecessary appendicectomies in 20 out of 210 (10%) children. our postoperative morbidity rates are as stated in figure.3, the wound infection rate was 53%(n = 26), adhesive bowel obstruction = 21%(n = 10), postoperative abdominal abscess = 14%(n = 7), and wound dehiscence = 12%(n = 6). In other studies, the wound infection rates in the published literature range from 5% in non-complicated appendicitis to 20% in complicated appendicitis. Lee and Ho et. al. [ 4 ] found that Wound infection arte = 2, and Intra-abdominal abscess rate = 3. Postoperative complications including surgical wound infections and abdominal abscesses occur in approximately (1 to 5) percent of kids with non-complicated appendicitis and (2 to 9) percent of those with advanced appendicitis. abdominal abscesses occur in 5 percent. Small intestinal obstruction from adhesions occurs in 1% of kids with advanced appendicitis. Conclusion Vague abdominal pain, nausea, vomiting, and anorexia are the most frequent presenting clinical findings of acute appendicitis in kids. Right lower quadrant tenderness is the most important clinical parameter in diagnosis of kids with acute appendicitis. Elevated WBC count, neutrophilia, and urine ketones are the most supportive biomarkers related to pediatrics acute appendicitis. Elevated CRP is poor predictor in diagnosis of pediatrics appendicitis. The prevalence of appendicoliths was 86.7% that mostly located at fecolith at mid of appendix. The perforation rate of pediatrics appendicitis was 62%. The most postoperative morbidities are the wound infection, adhesive bowel obstruction, postoperative abdominal abscess, and wound dehiscence. Declarations Consent: We declared that informed written consent has taken for publication from the legal guardian of the children with an under-standing that every effort will be made to conceal the identity of the patient. Ethical approval : This study was approved by the Ethics Committee of the University of Anbar and the reference number (223), Anbar, Iraq. Consent for publication: Patient identity did not appear in any part of the manuscript; therefore, consent for publication was not required. Availability of data and materials: Please contact corresponding author for data requests. Competing interests: None declared Funding: Nil Authors' contributions : The author contributed fully in concept, data acquisition, analysis, interpretation, and drafting of the manuscript. author has read and approved the final manuscript Acknowledgements: None. References Acheson J, Banerjee J. Management of suspected appendicitis in children. Archives of Disease in Childhood-Education and Practice. 2010 Feb 1;95(1):9-13. Choi JY, Ryoo E, Jo JH, Hann T, Kim SM. Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis. Korean journal of pediatrics. 2016 Sep;59(9):368. Marzuillo P, Germani C, Krauss BS, Barbi E. Appendicitis in children less than five years old: A challenge for the general practitioner. World journal of clinical pediatrics. 2015 May 5;4(2):19. Lee SL, Ho HS. Acute appendicitis: is there a difference between children and adults?. The American Surgeon. 2006 May;72(5):409-13. Shera AH, Nizami FA, Malik AA, Naikoo ZA, Wani MA. Clinical scoring system for diagnosis of acute appendicitis in children. The Indian Journal of Pediatrics. 2011 Mar;78:287-90. Afuwape OO, Ayandipo OO, Soneye O, Fakoya A. Pattern of presentation and outcome of management of acute appendicitis: A 10-year experience. Journal of Clinical Sciences. 2018 Oct 1;15(4):171-5. Zachos K, Fouzas S, Kolonitsiou F, Skiadopoulos S, Gkentzi D, Karatza A, Marangos M, Dimitriou G, Georgiou G, Sinopidis X. Prediction of complicated appendicitis risk in children. European Review for Medical & Pharmacological Sciences. 2021 Dec 1;25(23). Kim E, Subhas G, Mittal VK, Golladay ES. C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. International Journal of Surgery. 2009 Jan 1;7(1):74-7. Di AC, Parolini F, Morandi A, Leva E, Torricelli M. Do we need imaging to diagnose appendicitis in children?. African Journal of Paediatric Surgery. 2013 Apr 1;10(2):68-73. Smink DS, Finkelstein JA, Peña BM, Shannon MW, Taylor GA, Fishman SJ. Diagnosis of acute appendicitis in children using a clinical practice guideline. Journal of pediatric surgery. 2004 Mar 1;39(3):458-63. Oktay C, Goksu M, Yavuz S. Prevalence of appendicolith in children with acute appendicitis and its correlation with disease severity. Northern Clinics of Istanbul. 2023 Sep 14;10(5):631-5. Yoon HM, Kim JH, Lee JS, Ryu JM, Kim DY, Lee JY. Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and a high risk of perforation. World Journal of Pediatrics. 2018 Apr;14:184-90. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":83931,"visible":true,"origin":"","legend":"\u003cp\u003epresentation duration in our study:\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8627797/v1/839f767e55ed0143d917fe52.png"},{"id":100855855,"identity":"0439c512-1577-4bc5-9b45-d183b75912a0","added_by":"auto","created_at":"2026-01-22 06:57:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":89977,"visible":true,"origin":"","legend":"\u003cp\u003eFinal outcome in our study:\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8627797/v1/c922e67b16a44a2b55f6f635.png"},{"id":100855760,"identity":"93338c7c-0da6-4527-9949-5ecc6a8ffa57","added_by":"auto","created_at":"2026-01-22 06:56:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":105421,"visible":true,"origin":"","legend":"\u003cp\u003epostoperative complication in our study:\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8627797/v1/787e6f3bfd6df941aa50f067.png"},{"id":101794011,"identity":"8c53adc6-320b-4b18-bd3f-9ca03a44a8ec","added_by":"auto","created_at":"2026-02-03 16:26:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":674475,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8627797/v1/54243400-d2e9-4414-9edc-53de758f791d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Pediatric Acute Appendicitis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAcute appendicitis is the most commonly emergency etiology requires abdominal surgery in kids. Diagnosis of appendicitis may remain problematic, particularly in younger kids [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Delay diagnosis and intervention of appendicitis can be leading to complications such as mass, abscess, appendix perforation, peritonitis, small bowel obstruction, sepsis, and enterocutaneous fistula [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn one-third of children with appendicitis, the appendix ruptures prior to operative treatment. In early kids greater omentum is underdeveloped, therefore it does not localize the infection, and higher rate of perforation (23\u0026ndash;73) %, diffuse peritonitis can be developing. Because difficulties in communication and examination, there are several studies reporting challenging in diagnosis of children appendicitis, this will lead to higher rate of both negative appendectomies and delayed diagnosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Diagnosis of acute appendicitis is requiring combination of clinical information, biomarkers, and radiological imaging. However, unnecessary surgical intervention should be avoided, delayed diagnosis and management of acute appendicitis leads to higher rate of perforation, peritonitis, wound infection, intraabdominal abscess collection, and late adhesive intestinal obstruction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis is a retrospective study conducted in pediatric surgery department, between February 2023 to January 2025. It included 98 children presented with acute appendicitis for two years.\u003c/p\u003e \u003cp\u003eAll kids up to 14 years who were diagnosed and operated for acute appendicitis were included in the study. Those children who had chronic appendicitis were excluded from the study. The diagnosis of acute appendicitis was established by clinical findings, laboratory tests and ultrasound findings, finally was confirmed by macroscopic inspection during surgery, and combined with the histopathological analysis. Data was entered and analyzed using Microsoft Excel 2010.\u003c/p\u003e \u003cp\u003eElevated WBC was indicated for WBC more than 12.000 cells/mL.\u003c/p\u003e \u003cp\u003ePositive ultrasound was indicated for appendicular thickness more than 2mm, diameter more than 6mm, non-compressible a peristaltic tubular structure at right iliac fossa, and appendicular mass or abscess. Data was collected from child pertaining to age, sex, duration of presentation, clinical findings and other laboratory. ultrasonography (USG) was performed in all kids.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOver a period of study (24 months), 98 kids aged up to 14 years with a diagnosis of acute appendicitis were reviewed.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic characteristics of children with acute appendicitis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOut of 98 kids, 60(61%) were males and 38(39%) were females. We observed 55(56%) kids developed acute appendicitis at the age of (10\u0026ndash;12) years and the rest 31(32%) presented after the age of 12 years, and 12(12%) of kids at less than 10 years of age. Most of cases were presented in 24\u0026ndash;48 hrs.(figure.1)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1): Clinical features of children with acute appendicitis\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMigrating pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVague abdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever after pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea/ vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnorexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRLQ Tenderness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse abdominal tenderness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2): Laboratory and ultrasound finding.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated WBC count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophilia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive ultrasound finding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated CRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine ketones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3): Location of fecolith in our study.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecolith at base of appendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecolith at tip of appendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo fecolitth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecolith at mid of appendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe final outcome was including 62% of perforated appendicitis, 30% of non- perforated suppurative appendicitis(figure.2).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eour postoperative morbidity rates are (figure.3), the wound infection rate was 53%(n\u0026thinsp;=\u0026thinsp;26), adhesive bowel obstruction\u0026thinsp;=\u0026thinsp;21%(n\u0026thinsp;=\u0026thinsp;10), postoperative abdominal abscess\u0026thinsp;=\u0026thinsp;14%(n\u0026thinsp;=\u0026thinsp;7), and wound dehiscence\u0026thinsp;=\u0026thinsp;12%(n\u0026thinsp;=\u0026thinsp;6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eClinical presentation of acute appendicitis in kids are mostly similar with other frequent abdominal pathology, therefore, this may lead to difficulty in diagnosis. In the present study, 60(61%) were males and 38(39%) were females, and was consistent with the results of most literatures, boys outnumbered girls. We observed most of kids 55(56%) developed acute appendicitis at the age of (10\u0026ndash;12) years and the rest 31(32%) presented after the age of 12 years, and 12(12%) of kids at less than 10 years of age. This result is comparable with A. H. Shera et.al.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] who found that (45.6%) fall in the age10\u0026ndash;12 years, and by Richard J et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] who found that mean age of clinical presentation was in the age 11\u0026ndash;12 years.\u003c/p\u003e \u003cp\u003eThis study showed that durations of symptoms are (45%)within 1\u0026ndash;2 days after symptoms onset, (31%) after 3 days, and (24%) in the 1st day. Recent reports have shown that delayed presentation in the developing world as \u0026gt;\u0026thinsp;80% of kids have more history (\u0026gt;\u0026thinsp;24hours) of a prior visit to emergency department. The diagnostic delay in our study may be due to the children referred after been treated early in nurse clinics for several days or by pediatrician that depend on imaging studies to exclude acute appendicitis in treating kids who developed abdominal pain and other GIT symptoms, this will lead to misdiagnose acute appendicitis as gastroenteritis in early stage [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the common signs and symptoms at presentation are nausea/ vomiting (98%), anorexia (91%), right lower abdominal tenderness (78%), and vague abdominal pain (71%).\u003c/p\u003e \u003cp\u003ethe sensitivity of clinical parameters alone in diagnosis of kids with acute appendicitis between were (54\u0026ndash;70) % into (70\u0026ndash;87) % in adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Multiple studies have been published that pain migrating to the right lower quadrant, right lower quadrant tenderness, vomiting, fever, and nausea were very often concomitant clinical parameters that improve diagnostic accuracy of appendicitis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent reports have shown that higher WBC, and neutrophil count have been used to support prediction of (diagnosis) appendicitis. In our series, elevated WBC count (85%), Neutrophilia (84%), and urine ketones (78%) are the most common biomarkers related to pediatrics acute appendicitis, this result is constant with multiple studies that found elevated WBC count, and neutrophilia have significantly higher odds for acute appendicitis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. On the other hand, the specificity for elevated CRP (19%) was lowest and does not support prediction of (diagnosis) pediatrics appendicitis, this result is constant to E. Kim et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] who found that high CRP does not help in diagnosing pediatrics appendicitis.\u003c/p\u003e \u003cp\u003eIn our series, positive ultrasound finding for appendicitis in n\u0026thinsp;=\u0026thinsp;57(58%). Diagnosis of pediatrics acute appendicitis is based primarily on clinical examination, no specific diagnostic tool for pediatrics appendicitis. Some report said that use of CT and US scan may improve the accuracy of the diagnosis of pediatrics appendicitis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Others series found that the imaged studies did not have improvement in diagnostic accuracy/outcome when compared to clinical examination by an experienced pediatric surgeon. There are several limitations, and disadvantages of imaging modality: use of abdominal ultrasound scan not always available, and operative dependent. In addition to application of CT scanning must be with caution in kids because of risk of use contrast material and the radiation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the prevalence of appendicoliths was 86.7% (85/98), in Lowe et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] the prevalence of appendicoliths was 65%, while in Abeş et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] studies the prevalence was 46% and 54.6% in H. M. Yoon, et. al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] the difference of prevalence of appendicoliths may be related to the difference in the diet pattern (The positive correlation between low-fiber diet with appendicoliths appendicitis).\u003c/p\u003e \u003cp\u003eIn the present series, the location of fecolith (32%) at base of appendix, (46%) at mid of appendix, (9%) at tip of appendix, (12%) no fecolitth. In other series the location of fecolith (32%) at base of appendix, (39%) at mid of appendix, (28%) at tip of appendix, (1%) no fecolitth [13].\u003c/p\u003e \u003cp\u003eIn our study, the final outcome was confirmed by surgical and histopathological analysis which includes 62% of perforated appendicitis, 30% of non- perforated suppurative appendicitis.\u003c/p\u003e \u003cp\u003eMultiple studies found that the perforation rate in pediatrics was 19% and is ranging from (30\u0026ndash;45) % [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Unlike previous reports, our study had high rate of perforated appendicitis (62%), this result was supported by Afuwape, \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] who studied 313 of pediatrics acute appendicitis and found that rate of perforated appendix was 50%. High rate of Perforation could be due to high prevalence appendicoliths appendicitis is associated with appendiceal perforation, and delay in presentation.\u003c/p\u003e \u003cp\u003eIn our series, the unnecessary appendicectomy rate was 8%, other studies were observed rate of unnecessary appendicectomies in 16 out of 126(13%) children. In addition, Cesare, \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] found that negative appendectomy rate 8.8%. \u003cem\u003eLee and Ho et. al.\u003c/em\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] found that rate of unnecessary appendicectomies in 20 out of 210 (10%) children.\u003c/p\u003e \u003cp\u003eour postoperative morbidity rates are as stated in figure.3, the wound infection rate was 53%(n\u0026thinsp;=\u0026thinsp;26), adhesive bowel obstruction\u0026thinsp;=\u0026thinsp;21%(n\u0026thinsp;=\u0026thinsp;10), postoperative abdominal abscess\u0026thinsp;=\u0026thinsp;14%(n\u0026thinsp;=\u0026thinsp;7), and wound dehiscence\u0026thinsp;=\u0026thinsp;12%(n\u0026thinsp;=\u0026thinsp;6). In other studies, the wound infection rates in the published literature range from 5% in non-complicated appendicitis to 20% in complicated appendicitis. \u003cem\u003eLee and Ho et. al.\u003c/em\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] found that Wound infection arte\u0026thinsp;=\u0026thinsp;2, and Intra-abdominal abscess rate\u0026thinsp;=\u0026thinsp;3.\u003c/p\u003e \u003cp\u003ePostoperative complications including surgical wound infections and abdominal abscesses occur in approximately (1 to 5) percent of kids with non-complicated appendicitis and (2 to 9) percent of those with advanced appendicitis. abdominal abscesses occur in 5 percent. Small intestinal obstruction from adhesions occurs in 1% of kids with advanced appendicitis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eVague abdominal pain, nausea, vomiting, and anorexia are the most frequent presenting clinical findings of acute appendicitis in kids. Right lower quadrant tenderness is the most important clinical parameter in diagnosis of kids with acute appendicitis. Elevated WBC count, neutrophilia, and urine ketones are the most supportive biomarkers related to pediatrics acute appendicitis. Elevated CRP is poor predictor in diagnosis of pediatrics appendicitis. The prevalence of appendicoliths was 86.7% that mostly located at fecolith at mid of appendix. The perforation rate of pediatrics appendicitis was 62%. The most postoperative morbidities are the wound infection, adhesive bowel obstruction, postoperative abdominal abscess, and wound dehiscence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent:\u0026nbsp;\u003c/strong\u003eWe declared that informed written consent has taken for publication from the legal guardian of the children with an under-standing that every effort will be made to conceal the identity of the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical\u003c/strong\u003e \u003cstrong\u003eapproval\u003c/strong\u003e: This study was approved by the Ethics Committee of the University of Anbar\u0026nbsp;and the reference number (223), Anbar, Iraq.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003ePatient identity did not appear in any part of the manuscript; therefore, consent for publication was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003ePlease contact corresponding author for data requests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eNone declared\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNil\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: The author contributed fully in concept, data acquisition, analysis, interpretation,\u0026nbsp;and drafting of the manuscript.\u0026nbsp;author has read and approved the final manuscript \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAcheson J, Banerjee J. Management of suspected appendicitis in children. Archives of Disease in Childhood-Education and Practice. 2010 Feb 1;95(1):9-13.\u003c/li\u003e\n \u003cli\u003eChoi JY, Ryoo E, Jo JH, Hann T, Kim SM. Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis. Korean journal of pediatrics. 2016 Sep;59(9):368.\u003c/li\u003e\n \u003cli\u003eMarzuillo P, Germani C, Krauss BS, Barbi E. Appendicitis in children less than five years old: A challenge for the general practitioner. World journal of clinical pediatrics. 2015 May 5;4(2):19.\u003c/li\u003e\n \u003cli\u003eLee SL, Ho HS. Acute appendicitis: is there a difference between children and adults?. The American Surgeon. 2006 May;72(5):409-13.\u003c/li\u003e\n \u003cli\u003eShera AH, Nizami FA, Malik AA, Naikoo ZA, Wani MA. Clinical scoring system for diagnosis of acute appendicitis in children. The Indian Journal of Pediatrics. 2011 Mar;78:287-90.\u003c/li\u003e\n \u003cli\u003eAfuwape OO, Ayandipo OO, Soneye O, Fakoya A. Pattern of presentation and outcome of management of acute appendicitis: A 10-year experience. Journal of Clinical Sciences. 2018 Oct 1;15(4):171-5.\u003c/li\u003e\n \u003cli\u003eZachos K, Fouzas S, Kolonitsiou F, Skiadopoulos S, Gkentzi D, Karatza A, Marangos M, Dimitriou G, Georgiou G, Sinopidis X. Prediction of complicated appendicitis risk in children. European Review for Medical \u0026amp; Pharmacological Sciences. 2021 Dec 1;25(23).\u003c/li\u003e\n \u003cli\u003eKim E, Subhas G, Mittal VK, Golladay ES. C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. International Journal of Surgery. 2009 Jan 1;7(1):74-7.\u003c/li\u003e\n \u003cli\u003eDi AC, Parolini F, Morandi A, Leva E, Torricelli M. Do we need imaging to diagnose appendicitis in children?. African Journal of Paediatric Surgery. 2013 Apr 1;10(2):68-73.\u003c/li\u003e\n \u003cli\u003eSmink DS, Finkelstein JA, Pe\u0026ntilde;a BM, Shannon MW, Taylor GA, Fishman SJ. Diagnosis of acute appendicitis in children using a clinical practice guideline. Journal of pediatric surgery. 2004 Mar 1;39(3):458-63.\u003c/li\u003e\n \u003cli\u003eOktay C, Goksu M, Yavuz S. Prevalence of appendicolith in children with acute appendicitis and its correlation with disease severity. Northern Clinics of Istanbul. 2023 Sep 14;10(5):631-5.\u003c/li\u003e\n \u003cli\u003eYoon HM, Kim JH, Lee JS, Ryu JM, Kim DY, Lee JY. Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and a high risk of perforation. World Journal of Pediatrics. 2018 Apr;14:184-90.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"appendicitis, pain, appendectomy, and perforation","lastPublishedDoi":"10.21203/rs.3.rs-8627797/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8627797/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eWe evaluated the\u003cstrong\u003e \u003c/strong\u003edemographic characteristics, clinical presentation, diagnostic clues, morbidity, and the final outcomes of acute appendicitis in kids.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eAll kids up to 14 years who were diagnosed and operated for acute appendicitis were included in the study. The diagnosis of acute appendicitis was established by clinical findings, laboratory tests and ultrasound findings, finally was confirmed by macroscopic inspection during surgery, and combined with the histopathological analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOver a period of study (24 months), out of 98 kids, 61% were males and 39% were females. We observed 56% kids developed acute appendicitis at the age of (10-12) years. In this study, the common signs and symptoms at presentation are nausea/ vomiting (98%), anorexia (91%), right lower abdominal tenderness (78%), and vague abdominal pain (71%). Elevated WBC count (85%), Neutrophilia (84%), and urine ketones (78%) are the most common biomarkers related to pediatrics acute appendicitis. Positive ultrasound finding for appendicitis in n=57(58%). Prevalence of appendicoliths was 86.7%. Unnecessary appendicectomy rate was 8%. The most common morbidities are wound infection 53%, adhesive bowel obstruction= 21%, postoperative abdominal abscess= 14%, and wound dehiscence =12%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eVague abdominal pain, nausea, vomiting, and anorexia are the most frequent presenting clinical findings of acute appendicitis in kids. Right lower quadrant tenderness is the most important clinical parameter in diagnosis of kids with acute appendicitis. Elevated WBC count, neutrophilia, and urine ketones are the most supportive biomarkers related to pediatrics acute appendicitis. The most postoperative morbidities are the wound infection, adhesive bowel obstruction, postoperative abdominal abscess, and wound dehiscence.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Pediatric Acute Appendicitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 06:54:42","doi":"10.21203/rs.3.rs-8627797/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a58e8888-f6da-4dc7-994f-300bfe508865","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T16:25:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 06:54:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8627797","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8627797","identity":"rs-8627797","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}