ABSTRACT
PURPOSE: Acute appendicitis still remains one of the most common causes of childhood abdominal surgery. Despite of the development of modern diagnostic tools, it presents more serious problems than in adults due to the higher perforation rate. METHODS: In our hospital, 5-year term clinical reviews have been performed, over the last 2 decades to see if there were any changing tendencies of this disease entity. We reviewed 186 cases of child acute appendicitis between January 1997 and December 2001. RESULTS: The results were as follows: 1) The male to female ratio was 1.35: 1. 2) The peak incidence occurred in the 11 to 15 years old age group. 3) The overall perforation rate was 24.7%, which was decreased compared with 34.7% of our previous study (P<0.05, Odd ratio=0.60). 4) The negative exploration rate was 8.06%. 5) The overall complication rate were 2.85% and 32.6% in non-perforated and perforated cases, respectively. CONCLUSION: In conclusion, the incidence of acute appendicitis were shown to be almost the same as for the previous decade, but the perforation rate had dropped, maybe due to the early intervention, and advances in the diagnostic tools.
Subject(s)
Adult , Child , Female , Humans , Male , Appendicitis , Early Intervention, Educational , IncidenceABSTRACT
PURPOSE: Intussusception is a very common pediatric problem and needs early management. This study evaluated the risk factors of intussusception in infants and children for early diagnosis and treatment. METHODS: 216 cases of pediatric intussusception occurring between 1993 and 1999 in Mokpo Catholic Hospital were investigated retrospectively. 164 patients treated with barium reduction comprised the barium reduction (BR) group and 52 patients treated with manual reduction or bowel resection was operation (OP) group. RESULTS: The age incidence under 1 year old was 108 patients (65.9%) in BR group, 45 patients (86.5%) in OP group. Male to female ratio was 1.8:1 in BR and 1.7:1 in OP, respectively. In the seasonal distribution spring was more common in both group (34.1%, 34.6%). 60.4% in BR group, 76.9% in OP group were revealed leukocytosis above 10.000/mm3 in serum. Previous combined diseases were upper respiratory infection (31.7%, 42.3%), acute gastroenteritis (1.2%, 1.9%) and multiple familial polyposis (0.5% in BR group). The frequent symptoms and signs were bloody stool (86.0%,92.3%), abdominal pain and irritability (86.6%, 82.7%), vomiting (76.9%, 67.3%), and abdominal mass (56.7%, 76.9%). Tachycardia was 12.2% in BR and 44.2% in OP. In plain abdominal radiography, intestinal obstructive pattern was present in 5.5% of BR group and 53.8% of OP group. Success rate of barium reduction within 24 hours after symptom appearance was 82.3%. Within 24-48 hours was 61.1%, above 48 hours was 25%. There was a statistically significant difference between BR group and OP group of patients under 1 year old, with tachycardia, symptoms for longer than 48 hours and obstructive pattern on plain abdominal radiography (p<0.05). Of surgical cases, 84.6% were idiopathic. The common anatomical type was ileo-colic type (53.9%). The methods of operation were manual reduction (94.2%) and bowel resection (5.8%). Postoperative complications occurred in 4 cases; 3 cases of wound infection and 1 case of pulmonary complication. Recurrence rate was 12.8% in BR group. CONCLUSION: Risk factors of high incidence such as under 1 year old, severe obstructive pattern on the plain abdominal radiograph, symptoms for longer than 48 hours, and tachycardia, were related with a low success rate of barium reduction. Therefore, a gentle barium enema is recommended in high risk patients for diagnosis and prompt surgical intervention.