PREVALENCE AND RISK FACTORS OF PERFORATED APPENDICITIS AMONG CHILDREN ADMITTED TO SPHMMC SURGICAL WARD: A THREE YEARS RETROSPECTIVE ANALYSIS (2013-2015G.C)

Abstract

ABSTRACT Background: Appendicitis is the most common indication for abdominal surgery in children presenting to the emergency department. Because of the frequently atypical presentation of appendicitis in children, delayed diagnosis is common. Although the risk decreases with age, perforation has been reported in more than three quarters of children in the first 4 years of life at the time of surgery. The special diagnostic challenges of appendicitis in children, along with the greater dangers of misdiagnosis, delay and perforation, make swift and accurate diagnosis of appendicitis essential for emergency clinicians. Objective: To assess the prevalence and risk factors for perforation of appendix among pediatric patients with acute abdomen admitted to SPHMMC surgical ward in the years2013-2015 G.C. Methods and materials: This study was a retrospective analysis of children ages 2‐16 years with the diagnosis of acute appendicitis and admitted to SPHMMC in 2013-2015. 246 patient’s charts was selected. Data was collected from charts of patients in the study population using data collection instrument. Data from charts was entered to SPSS 21.0 analyzed for different sociodemographic variables were done. Result and conclusion: Among 246 study subjects the ranges was from 5 to 16 with mean of 10.7+2.9 years. 100% of the total study subjects had abdominal pain. Of the total patients, 92.7% had vomiting during their presentation. Among the study subjects 43.5% were febrile. 60.6% of the study subjects were tachycardia. RLQ tenderness was present in all 246 of the study subjects while rebound tenderness was detected in 90.7%. Bowel sound was active in 82.5% while decreased/absent in 17.5% of the study subjects. Among this children 53.2% and 2.8% has leukocytosis and leukopenia respectively. 62.2% have neutrophilia. Among the patients operated for acute appendicitis 61.3% were initially assessed and operated for simple acute appendicitis. 4.5% were admitted with assessment of perforated appendix. Intraoperative finding of the study subjects show that 62.6% have simple appendicitis while 25.2% have perforated appendix found intraoperative. The post-operative course of 87% were uneventful and children were discharged improved. 3.3% children in this study died. The duration of hospital stay ranged from 2 to 28 days. Presence of tachycardia, duration of symptoms, presence of absence/decreased bowel sound and neutrophilia has statistically significant association with perforation of appendix. Recommendation: it is recommended that the hospital administrator should use allocate resources based on this result. Clinicians are recommended to have early diagnosis to avoid perforation of appendix. Other researchers are recommended to perform similar researches onthe area. Key words: acute appendicitis, perforation, SPHMMC, children