IMPORTANCE OF DIARRHEA AS A PRESENTING SYMPTOM OF APPENDICITIS IN VERY YOUNG-CHILDREN

BACKGROUND: Appendicitis is an uncommon diagnosis in very young childr en. It is frequently complicated by delays in diagnosis, perforation, and lengthy hospital stays. OBJECTIVES: To review our recent experienc e with appendicitis among children younger than 3 years old, and to id entify the independent predictors of a prolonged hospital stay. METHOD S: A retrospective case series review was performed on all children un der age 3 who had an appendectomy for appendicitis between January 198 3 and February 1994. Multiple regression analysis was used to identify the independent predictors of a prolonged hospital stay, RESULTS: Six ty-three children were identified. Mean age was 2.2 years (range 11 to 35 months), The mean delay from onset of symptoms to presentation was 4.3 days. Fifty-seven percent were initially misdiagnosed. Diarrhea w as reported in 33%. Perforation and/or gangrene were found in 84%, Per foration and/or gangrene at laparotomy and a history of diarrhea at pr esentation were independent predictors of a prolonged hospital stay, C ONCLUSIONS: Appendicitis in children under 3 years old is characterize d by delays in diagnosis and perforation. A history of diarrhea is an important factor that confuses the diagnosis, prolongs the observation period, and delays appropriate therapy. (C) 1997 by Excerpta Medica, Inc.