Intraabdominal pressure: a parameter helpful for diagnosing and predicting a complicated course in children with appendicitis

Risk factors for the development of complicated appendicitis in adults

OBJECTIVE

To investigate the patient's history and physical examination information to find out risk factors associated with complicated appendicitis.

MATERIAL AND METHODS

Two hundred patients who were admitted with complicated appendicitis (including abscess, phlegmon, and generalized peritonitis) were retrieved from our database. Two hundred patients with non-complicated acute appendicitis were randomly selected from the same period. These two groups were compared in terms of demographic characteristics, past medical history, and presenting symptoms. We made a multivariate analysis model using binary logistic regression and backward stepwise elimination.

RESULTS

Based on multivariate analysis, risk factors for complicated appendicitis included presenting with epigastric pain (OR=3.44), diarrhea (OR=23.4) or malaise (OR=49.7), history of RLQ pain within the past 6 months (OR=4.93), older age (OR=1.04), being married (OR=2.52), lack of anorexia (OR=4.63) and longer interval between onset of symptoms and admission (OR=1.46). Conversely, higher (academic) education was associated with decreased odds for complicated appendicitis (OR=0.26).

CONCLUSION

Our findings suggest that a surgeon's clinical assessment is more reliable to make a judgment. "Bedside evaluation" is a useful, cheap, quick and readily available method for identifying those at risk for developing complicated acute appendicitis.

An exceptional complication following appendectomy: acute inguinal and scrotal suppuration

Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.

Excessive sac pressures: the pathogenesis and innocence of hydroceles in children

OBJECTIVE

To determine whether paediatric hydroceles result entirely from a small-calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms.

PATIENTS AND METHODS

Twenty-five hydroceles were studied prospectively in 24 boys (aged 18-132 months). Consent for the intraoperative measurements was obtained before surgery. The hydrocele was repaired under general anaesthesia with endotracheal intubation, using a standard approach, taking care not to open the sac during mobilization. Intra-abdominal pressures during surgery were measured indirectly via a nasogastric tube after gastric decompression. The pressure in the sac was measured via a 20 G intravenous cannula inserted via a purse-string suture. The relative pressure was then calculated by subtracting the intra-abdominal from the sac pressure. The effects of age and laterality were evaluated.

RESULTS

The median (range) intra-abdominal, sac and relative pressures were 8 (2-18), 11 (3-30) and 4 (3-30) cmH2O, respectively. The sac pressure in the sac was greater than the intra-abdominal pressure in 17 of 25 (68%; P = 0.004) patients. Age or laterality had no significant influence on any of the pressures.

CONCLUSIONS

These results suggest that in a significant proportion of hydroceles in children the pressures are higher than the intra-abdominal pressure. Therefore, they cannot be explained simply as a freely communicating, narrow-calibre processus. In addition, the pressures may reach levels which are potentially damaging to the testis.