Clinical features and treatment outcomes in obese children with appendicitis

Authors

  • Kanokrat Thaiwatcharamas Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Paisarn Vejchapipat Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
  • Prapapan Rajatapiti Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
  • Katawaetee Decharun Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand

Keywords:

Obesity, appendicitis, children, complication

Abstract

Background: Even developing countries are facing problems of childhood obesity. Diagnosis and treatment of appendicitis in obese children can sometimes be challenging. This study compared clinical features and treatment outcomes between non-obese and obese children clinically diagnosed as appendicitis.

Methods: Children (0 - 15 years) diagnosed as appendicitis between 2007 and 2013 were reviewed. Children were categorized into non-obese and obese groups using weight for height (> 140.0% of ideal body weight) based on the data of the Ministry of Public Health. Demographic data, clinical data, and treatment outcome were studied. Comparisons between non-obese and obese children were carried out. SPSS was used for all statistical analyses. Data are expressed as mean gif.latex?\pm standard deviation.

Results: There were 268 children (222 non-obese and 46 obese) pre-operatively diagnosed as appendicitis. All patients underwent open appendectomy. Body mass index (BMI) of non-obese children was 18.3 gif.latex?\pm 3.5 kg/m2 whereas BMI of obese children was 27.2 gif.latex?\pm4.3 kg/m2 , (P < 0.0001). There was no difference in age between the 2 groups (non-obese vs. obese, 10.6 gif.latex?\pm 2.7 vs. 10.5 gif.latex?\pm 2.2 yr., P = 0.84). The majority of patients sought medical attention within 24 hours in both groups (67.0% vs. 76.0%, P = 0.23). Imaging studies (ultrasound or computed tomography) was used to confirm the diagnosis in 6.3%. There was no difference between non-obese and obese groups regarding operative time (71.3 gif.latex?\pm 26.4 vs. 77.9 gif.latex?\pm 28.1 min, P = 0.13), negative appendectomy rate (6.7% vs. 8.7%, P = 0.75), perforation rate (17.1% vs. 9.0%, P = 0.25), hospital stay (94 gif.latex?\pm 64 vs. 81 gif.latex?\pm 39 hr., P = 0.19) and wound infection (4.9% vs. 4.3%, P = 0.99).

Conclusion: Approximately one-fifth of children undergone appendectomy were obese. Our data suggest that obesity might not be associated with increased difficulty in making the diagnosis of appendicitis in children. However, childhood obesity appears to be associated with potentially more difficult surgery, as the increase in operative times.

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References

Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473-82. https://doi.org/10.1016/S0140-6736(02)09678-2

Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet 2010;375:1737-48.

https://doi.org/10.1016/S0140-6736(10)60171-7

Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11-25. https://doi.org/10.1080/17477160600586747

Langendijk G, Wellings S, van Wyk M, Thompson SJ, McComb J, Chusilp K. The prevalence of childhood obesity in primary school children in urban Khon Kaen, northeast Thailand. Asia Pac J Clin Nutr 2003;12:66-72.

Nguyen T, Kamsrichan W, Chompikul J. Obesity and related factors among students grade 7-12 in Phutthamonthon districts, Nakhon Pathom, Thailand. J Public Health Develop 2008;6:91-101.

Sengmeuang P, Kukongviriyapan U, Pasurivong O, Jones C, Khrisanapant W. Prevalence of obesity among Thai schoolchildren: a survey in Khon Kaen, Northeast Thailand. Asian Biomed 2010;4:965-70.

https://doi.org/10.2478/abm-2010-0128

Hong SA, Sriburapapirom C, Thamma-Aphiphol K, Jalayondeja C, Tiraphat S. Overweight and obesity among primary schoolchildren in Nakhon Pathom, Thailand: comparison of Thai, international obesity task force and WHO Growth references. Southeast Asian J Trop Med Public Health 2017;48:902-11.

Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect 2015;21:1008. https://doi.org/10.1016/j.cmi.2015.07.003

Blanco FC, Sandler AD, Nadler EP. Increased incidence of perforated appendicitis in children with obesity. Clin Pediatr (Phila) 2012;51:928-32. https://doi.org/10.1177/0009922812441659

Hawn MT, Bian J, Leeth RR, Ritchie G, Allen N, Bland KI, et al. Impact of obesity on resource utilization for general surgical procedures. Ann Surg 2005;241:821-6.

https://doi.org/10.1097/01.sla.0000161044.20857.24

Department of Health Ministry of Public Health, Thailand. Table: Weight by age. In: National growth references for Thai children under 20 years of age. Bangkok: War Veterans Organization; 1999. p. 28-83.

Meier DE, Guzzetta PC, Barber RG, Hynan LS, Seetharamaiah R. Perforated appendicitis in children: is there a best treatment? J Pediatr Surg 2003;38:1520-4. https://doi.org/10.1016/S0022-3468(03)00549-9

Davies DA, Yanchar NL. Appendicitis in the obese child. J Pediatr Surg 2007;42:857-61.

https://doi.org/10.1016/j.jpedsurg.2006.12.040

Ramos CT, Nieves-Plaza M. The association of body mass index and perforation of the appendix in Puerto Rican children. J Health Care Poor Underserved 2012; 23:376-85.

https://doi.org/10.1353/hpu.2012.0017

Chaiprasit P. Childhood appendicitis in regional hospital. Thai J Surg 2011;32:73-6.

Brender JD, Marcuse EK, Koepsell TD, Hatch EI. Childhood appendicitis: factors associated with perforation. Pediatrics 1985;76:301-6. https://doi.org/10.1542/peds.76.2.301

Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 2000;16:160-2. https://doi.org/10.1097/00006565-200006000-00005

Ponsky TA, Huang ZJ, Kittle K, Eichelberger MR, Gilbert JC, Brody F, et al. Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children. JAMA 2004;292:1977-82. https://doi.org/10.1001/jama.292.16.1977

Kutasy B, Hunziker M, Laxamanadass G, Puri P. Increased incidence of negative appendectomy in childhood obesity. Pediatr Surg Int 2010;26:959-62. https://doi.org/10.1007/s00383-010-2646-x

Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120 Suppl 4:S193-228. https://doi.org/10.1542/peds.2007-2329D

Schuh S, Man C, Cheng A, Murphy A, Mohanta A, Moineddin R, et al. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr 2011;158:112-8

https://doi.org/10.1016/j.jpeds.2010.07.035

Hörmann M, Scharitzer M, Stadler A, Pokieser P, Puig S, Helbich T. Ultrasound of the appendix in children: is the child too obese? Eur Radiol 2003;13:1428-31. https://doi.org/10.1007/s00330-002-1747-x

Garey CL, Laituri CA, Little DC, Ostlie DJ, St Peter SD. Outcomes of perforated appendicitis in obese and nonobese children. J Pediatr Surg 2011;46:2346-8. https://doi.org/10.1016/j.jpedsurg.2011.09.024

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Published

2023-10-17

How to Cite

1.
Thaiwatcharamas K, Vejchapipat P, Rajatapiti P, Decharun K. Clinical features and treatment outcomes in obese children with appendicitis. Chula Med J [Internet]. 2023 Oct. 17 [cited 2024 May 20];65(1). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/1075

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Vol. 65 No. 1 (2021): Chulalongkorn Medical Journal

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Original Articles

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