Dragoljub Živanović, Ivona Đorđević, Milan Petrović

DOI Number
First page
Last page


Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinical presentation of appendicitis may be significantly different in children. Diagnosis is based on the combination of symptoms, clinical signs, and results of laboratory and radiology examinations. The objective of the present study was to analyze symptoms, signs, laboratory and histopathology findings in children who underwent surgery for acute appendicitis. Sixty-seven patients (37 males and 30 females) with mean age of 9.77 years, operated on for clinical diagnosis of acute appendicitis were enrolled in the study. Abdominal pain was present in all patients, followed by vomitus and fever. Laboratory markers of inflammation varied significantly with severity of inflammation, but were normal in chronic appendicitis. Clinical and histopathology assessments of inflammation were concordant in 22 – 43% depending of the degree of appendicitis. Perforation occurred in 26.86% and negative appendectomy rate was 6%.


appendicitis, children, appendectomy, histopathology

Full Text:



Sudhakaran N, Ade-Ajayi N. Appendicitis in children. Surgery. Elsevier Ltd; 2010; 28:16–21.

Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis. Alpern E, editor. Acad Emerg Med 2017; 24:523–551.

Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, et al. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 2003; 38:372-9-9.

Alloo J, Gerstle T, Shilyansky J, Ein SH. Appendicitis in children less than 3 years of age: a 28-year review. Pediatr Surg Int 2004; 19:777–779.

Marjanović Z, Spasić Z, Zivanović D, Kostić A, Djordjević I ZD. Akutni apendicitis kod dece uzrasta do tri godine. Srp Arh Celok Lek 2006; 134:203–207.

Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med. Elsevier B.V.; 2010;2–5.

Stevenson MD, Dayan PS, Dudley NC, Bajaj L, Macias CG, Bachur RG, et al. Time From Emergency Department Evaluation to Operation and Appendiceal Perforation. Pediatrics. 2017;139.

Tsuji M, Puri P, Reen DJ. Characterisation of the local inflammatory response in appendicitis. J Pediatr Gastroenterol Nutr 1993; 16:43–48.

Wang Y, Reen D, Puri P. Is a histologically normal appendix following emergency appendicectomy always normal? Lancet. Elsevier. 1996; 347:1076–1079.

Nemeth L, Reen DJ, O’Briain DS, McDermott M, Puri P. Evidence of an inflammatory pathologic condition in “normal” appendices following emergency appendectomy. Arch Pathol Lab Med 2001; 125:759–764.

Wu Hp, Chen C, Kuo I, Wu Y, Fu Y. Diagnostic Values of a Single Serum Biomarker at Different Time Points Compared with Alvarado Score and Imaging Examinations in Pediatric Appendicitis. J Surg Res. Elsevier Inc; 2012;174:272–177.

Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28–37.

Siddique K, Baruah P, Bhandari S, Mirza S, Harinath G. Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis. JRSM Short Rep 2011; 2:59.

Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/

lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010; 52:400–403.

Morrow SE, Newman KD. Current management of appendicitis. Semin Pediatr Surg 2007; 16:34–40.

Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000; 36:39–51.

Livingston EH, Woodward W a, Sarosi G a, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 2007; 245:886–892.

Kwok MY, Kim MK, Gorelick MH. Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 2004; 20:690-8-701.

Golledge J, Scriven M. Peritonism in appendicitis. Ann R Coll Surg Engl 1996; 78:11–14.

O’Shea JS, Bishop ME, Alario AJ, Cooper JM, others. Diagnosing appendicitis in children with acute abdominal pain. Pediatr Emerg Care 1988; 4:172.

Andersson RE, Hugander a P, Ghazi SH, Ravn H, Offenbartl SK, Nyström PO, et al. Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 1999; 23:133–140.

Roberts JK, Behravesh M, Dmitrewski J. Macroscopic findings at appendicectomy are unreliable: implications for laparoscopy and malignant conditions of the appendix. Int J Surg Pathol 2008; 16:386–390.

Bliss D, Mckee J, Cho D, Krishnaswami S, Zallen G, Harrison M, et al. Discordance of the pediatric surgeon’s intraoperative assessment of pediatric appendicitis with the pathologists report. J Pediatr Surg. Elsevier Inc.; 2010; 45:1398–1403.

St Peter SD, Sharp SW, Holcomb GW, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. Elsevier Inc.; 2008; 43:2242–2245.

Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD CA. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg 2004; 39:464–469.

Oyetunji TA, Ong’uti SK, Bolorunduro OB, Cornwell EE 3rd NB. Pediatric negative appendectomy rate: trend, predictors, and differentials. J Surg Res. Elsevier Inc; 2012; 173:16–20.

Almström M, Svensson JF, Patkova B, Svenningsson A, Wester T. In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children. Ann Surg 2017; 265:616–621.



  • There are currently no refbacks.

ISSN 0354-2017 (Print)

ISSN 2406-0526  (Online)