Bowel movement patterns in children with acute appendicitis

ABSTRACT

Acute appendicitis is currently one of the most important causes of acute abdominal peritonitis and emergency laparatomy. Despite its low mortality, it remains a cause of concern for surgeons due to the postoperative complications of wound infection, sepsis, intrabdominal abscess and even bowel obstruction resulting from adhesions. High incidence of acute appendicitis provides a strong impetus for further studies. This study was conducted to determine the bowel movement patterns and dietary fiber consumption in pediatric patients with appendicitis in Shiraz, southern Iran. The study included 202 pediatric patients under the age of 18 years at Nemazee Hospital affiliated to Shiraz University of Medical Sciences, who had undergone appendectomy with the preoperative diagnosis of acute appendicitis from March 2003 to March 2004. Using a written semi-standard questionnaire, the variables recorded were age, gender, stool consistency, number of bowel movements, type of bread consumed, habit of fruit and vegetable consumption, clinical presentation [signs and symptoms] and the time taken from the onset of symptoms to arrival in hospital, the date of patients admission to the emergency room to the time of surgery, and the duration of postoperative hospitalization. The pathology of appendicitis was clarified and recorded. The patients aged from 3-18 years [mean 11.2 +/- 3.6 years], with a male to female ratio of 24. Anorexia was the most common symptom, affecting 78.7% of patients. Of 31 patients with constipation, 58% did not report daily regular intake of fruits while the others had regular fruit intake. Only 3 patients [9.7%] had regular daily consumption of vegetables, and 27 patients [87.1%] had pathology reports of fecalith, while in the nonconstipated patients, only 1.2% had such reports. The abdominal pain was periumbilical in many patients [42.6%], which shifted to McBurny point in most [96%] patients. 134 patients [66.3%] visited a health center within 24 hours after the first symptoms. Surgeries were performed on 132 patients [65.3%] within 6 hours, on 67 patients [33%] within 6-12 hours, and on 3 patients [2%] in more than 12 hours. Our findings suggest a high rate of constipation in patients with lower fiber intake, which is consistent with the hypothesis indicating the role of dietary fibers in lowering the incidence of appendicitis