Intraabdominal pressure: A parameter helpful for diagnosing and predictinga complicated course in children with appendicitis

Background/Purpose: The intraabdominal pressure (IAP) of children presentin g with acute, perforated, or suspected appendicitis were determined and com pared to define if the IAP has any diagnostic value or helps to predict a c omplicated course. Methods: Eighty-four patients with a initial diagnosis of appendicitis were evaluated. In addition to preoperative measurements, IAP of each patient w as determined repeatedly on the postoperative first, second, and third days . The patients were grouped according to the final diagnoses as acute, perf orated, or suspected appendicitis or negative exploration. The preoperative and postoperative IAP of the patients were compared among the groups. Post operative complications were recorded, and IAP of those patients were addit ionally compared with the others in the same group. Results: Whereas a normal appendix was found in 4 of the operated patients, 27 and 38 patients had acute and perforated appendicitis, respectively. Th e mean preoperative values of IAP for acute, perforated, or suspected appen dicitis and negative exploration were 6.2 +/- 0.4, 9 +/- 0.3, 0.3 +/- 0.4, and 3 +/- 0.4 cm H2O, respectively (P < .001). Postoperative first day and second day values of the IAP for acute appendicitis, perforated appendiciti s, and negative laparotomy groups were 2 +/- 0.2 and 0.6 +/- 0.1, 3 +/- 0.1 and 1.5 +/- 0.1, 0.5 +/- 0.6 and -0.2 +/- 0.6 cm H2O, respectively. The di fference between acute and perforated appendicitis groups was significant ( P < .05). Wound infection was encountered in 7 among 38 patients with perfo rated appendicitis. The preoperative and first postoperative day IAP values of patients with perforated appendicitis who experienced a wound infection and who were without a wound infection have been 11.8 +/- 0.4 and 4.8 +/- 0.2, and 8.4 +/- 0.2 and 3.1 +/- 0.3 cm H2O (P < .001). Discriminant analys is has shown that 93.3%, 70.4%, and 73.3% of patients with suspected, acute , and perforated appendicitis have been within the expected groups. IAP les s than 1.39 cm H2O has excluded appendicitis with a 95% confidence interval . Although the interval has been between 5.40 and 7.04 cm H2O for acute app endicitis, it has varied between 8.46 and 9.70 cm H2O for perforated append icitis. Conclusions: Although the IAP does not increase in conditions mimicking app endicitis, it increases among children with appendicitis. A further increas e is encountered among children with perforated appendicitis. Complicated c ourse is encountered among children with highest IAP values. Therefore, IAP may be used both as a diagnostic parameter and a predictor of a complicate d course associated with appendicitis in children. Copyright (C) 2000 by W. B. Saunders Company.