Characteristics and Clinical Outcomes Associated with Appendix Location in Children with Acute Appendicitis

Abstract PURPOSE: To categorize appendix location with a modified classification system and describe the outcomes associated with each location. METHODS: This was a prospective observational cohort study of children who underwent laparoscopic appendectomy at a reference children’s hospital. The diagnosis of acute appendicitis (AA) was confirmed by the pathology department, and clinical history data were obtained. The location of the appendix was classified as retrocecal (RA), pelvic (PEA), or right iliac fossa (RIF), and an intraoperative photograph was taken for confirmation. RESULTS: The location of the appendix was divided into three groups (RIF 42%, PEA 33%, and RA 25%). Significant differences were found in the time of symptom onset (RA >48 hours in 54.5% of patients, p=0.001) and in the ultrasound diagnosis of appendicitis (RIF 49.3%, RA 25.9%, PEA 24.6%, p=0.01). The primary outcome assessed was appendix perforation, which also significantly differed between appendix locations (average 37.8%, PEA 46%, p=0.001). CONCLUSIONS: The classification of the location of the appendix in RIF, PEA and RA was clear, simple, and reproducible, with RIF being the most common location. Pelvic localization was associated with the presence of perforation, possibly because signs of peritoneal irritation are less usual in these children, and perforation was less observed via ultrasound.