Predictive value of TLC and CRP in children with clinically suspected acute appendicitis

Acute appendicitis represents one of the most common abdominal emergencies in children. Initially inflammation is localized to appendix but if untreated can lead to generalized peritonitis. It is often difficult and challenging even for the most experienced surgeon to make a definite diagnosis in paediatric patients. Inflammatory markers like Total Leukocyte count [TLC] and C-reactive protein [CRP] can help in making an early and accurate diagnosis in difficult cases

Objective: To evaluate the predictive value of TLC and CRP in children with clinically suspected acute appendicitis in whom physical findings were equivocal

Study Design: Cross sectional analytical

Setting: This study was conducted in Pediatric Surgery Department of Shaikh Zayed Postgraduate Medical Institute, Lahore

Subjects and Methods: All patients from 5-14 years of age fulfilling the inclusion criteria were admitted for this study. Preoperative blood samples for total leukocyte count and CRP were collected and submitted to hematology and microbiology laboratories. Postoperatively, specimen of appendix was sent to histopathology laboratory of Shaikh Zayed Hospital. The histological results of report were differentiated into non-inflammcd and inflamed appendix

Results: The mean age of the patients was 9.9+/-2.2 years. The mean TLC of the patients was 14.1+/-6.4 [10[9]/L]. The mean CRP of the patients was 19.0+/-8.7 mg/dl. Histopathology showed that 70 [69.4%] patients had inflamed appendix. The sensitivity of TLC and CRP was 82%, specificity 75% and diagnostic accuracy was 79%. The positive predictive value of TLC and CRP was 83% and negative predictive value was 73%

Conclusion: It is concluded from the results of this study that TLC and C-reactive protein can provide help in making accurate diagnosis of acute appendicitis. There monitoring enhances the diagnostic accuracy of acute appendicitis thus reducing the morbidity associated with delay in diagnosis and negative explorations

Hazards of multiple magnet ingestion in children; a case report

Foreign body ingestion is relatively common in the paediatric population and most object pass through the gastrointestinal tract spontaneously. With the popularity of small magnetic toys, there have been numerous reports of magnet ingestion with morbidity and even mortality. We report a case of 3-years old boy who presented with clinical features of subacute intestinal obstruction with no history of foreign body ingestion. On exploratory laparotomy, he was found to have multiple small bowel perforations due to two small magnets. Magnets were removed and perforations repaired. The aim of this report is to aware paediatricians of the importance of early surgical referral in case of magnet ingestion, to prevent severe complications