Clinical features and pathogenic analysis of acute appendicitis in children

Objective To analyze the clinical features and pathogen characteristics of acute appendicitis in children. Methods We retrospectively reviewed the data of 149 children with acute appendicitis treated in our hospital between January 1, 2018 and November 30, 2018, and analyzed their clinical features, laboratory test results, therapeutic effects, results of bacterial culture and drug sensitivity of the bacteria. Results ① The children had an average age of 7 years and 7 months with a male to female ratio of 1.57 :1.00. ②The main clinical manifestations included abdominal pain (99.32%), digestive tract symptoms (79.87%) and fever (65.77%). All the children had abdominal tenderness, could be accompanied by such peritonitis signs as rebound pain (81.21%) and muscle tension (77.18%). ③The incidence of clinical symptoms and signs did not differ significantly among different age groups. The children with different pathological types showed significant differences in peripheral blood white blood cell (WBC) counts, percentage of neutrophils and C-reactive protein (CRP) level (P < 0.05), and WBC counts were higher in children with gangrenous appendicitis and lower in children with uncomplicated appendicitis; these parameters did not differ significantly among different age groups. The positive rate of ultrasonography was 82.55% in these children, and abdominal inflammatory lesion was the predominant finding by B-mode ultrasound. ④Of the 149 children, 14 had acute simple appendicitis (9.40%), 49 had acute suppurative appendicitis (32.89%) and 86 had acute gangrenous appendicitis (57.71%). The incidences of appendicitis of different pathological types differed significantly among children with different disease courses (P < 0.001); a disease course over 1 d was associated with a significantly increased risk of gangrenous appendicitis. Residual abdominal infection was the most common postoperative complication (29.53%), which was more likely in cases of gangrenous appendicitis, and its incidence differed significantly among different pathological types (chi-square=24.463, P < 0.001). ⑤Bacterial culture of the pus was performed in 75.84% of the cases, and the positive rate was 81.42%. Most of the pathogens identified were Gram-negative bacteria (81.15%), consisting predominantly of Escherichia coli (70.70%) and Pseudomonas aeruginosa (22.22%). Drug sensitivity tests showed that the pathogenic bacteria (both Gram-negative and -positive) were highly sensitive to meropenem and imipenem; the gram-negative bacteria showed a high sensitivity to semisynthetic penicillins and the third generation cephalosporins. ⑥The children received double or triple antibiotic therapies after the operation, which resulted in positive response rates of 97.22% and 99.10%, respectively. The children showing poor responses to the double and triple therapies were cured after treatment with the special class antibiotics such as meropenem and imipenem. Conclusion The clinical manifestations are atypical in children with acute appendicitis, for which a clinical diagnosis is made based primarily on the presence of right lower abdominal pain and fixed tenderness, and peripheral blood tests and abdominal B-ultrasound only have limited diagnostic values. Once diagnosed, prompt operation should be performed with standardized use of postoperative antibiotics in children with acute appendicitis.