Characteristics and Clinical Outcomes Associated with Appendix Location in Children with Acute Appendicitis

Abstract

PURPOSE To categorize appendix location with a modified classification and describe the outcomes associated to each location. METHODS Prospective observational cohort study of children who underwent laparoscopic appendectomy in a reference children’s hospital; the diagnosis of acute appendicitis (AA) was confirmed by the pathology department and clinical history data were taken. The location of the appendix was classified as retrocecal (RA), pelvic (PEA), right Iliac fossa (RIF) and an intraoperative photograph was taken for confirmation. RESULTS The location of the appendix was divided in three groups (RIF 42%, PEA 33%, RA 25%). Significant differences were found in time of symptom onset (RA > 48 hours in 54.5% of patients p: 0.001) and in the ultrasound diagnosis of appendicitis (RIF 49.3%, RA 25.9%, PEA 24.6% p: 0.01). The primary outcome assessed was appendix perforation, also with significant differences between appendix locations (average 37.8%, PEA 46% p: 0.001). CONCLUSION The classification of the location of the appendix in RIF, PEA and RA is clear, simple, and reproducible, being RIF the most frequent location. The pelvic localization was associated with the presence of perforation, possibly because signs of peritoneal irritation are less common in these children, and it was less visualized on ultrasound.