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Diagnostic Laparoscopy and Appendicectomy for Children with Chronic Right Iliac Fossa Pain – An Aggregate Analysis (Abstract)

Paul Charlesworth, Anies Mahomed
Department of Paediatric Surgery, Royal Alexandra Hospital for Sick Children

Brighton, United Kingdom

 

Abstract 

Introduction: Chronic right iliac fossa pain is a common paediatric complaint yet there are relatively few published series on its management. The aim of this paper is to evaluate a cohort of patients presenting with chronic right iliac fossa pain and managed by laparoscopy. A review of the current literature is presented.

Material and methods: Data was extracted from a prospective database of laparoscopic appendicectomy patients who met the criteria for chronic right iliac fossa pain. A retrospective case note review was undertaken. A literature search of published material on the condition was performed using Medline and Pubmed.

Result: Over a 4 year period from October 2003 sixteen children underwent laparoscopic appendicectomy for chronic right iliac fossa pain. Thirteen (81%) were female. The median age was 12 years 2 months with range of 9 years 6 months to 14 years 4 months. No patients had undergone previous abdominal surgery. The duration of pre-operative symptoms was 10 months, range (1-30). All preoperative laboratory and radiological investigations were inconclusive. The appendix was macroscopically normal in 14/16 (88%) patients. Four patients were noted to have adhesions. There was early improvement in 14/16 patients, which is a correlation of 88% between procedure and symptom resolution. This figure had improved to a 100% over the medium term. Median follow-up is 19 months, range 1-47. The correlation between symptoms and positive finding on histology or at laparoscopy was 100%. A literature review of the paediatric cases revealed 159 predominantly female patients. Symptom resolution following appendicectomy ranged between 70.6 and 90%. Positive histology was present between 30 and 86% of patients.

Conclusion: The evidence from this study and the literature supports laparoscopic appendicectomy in all patients presenting with chronic right iliac fossa pain following negative radiological and serological investigations. Symptomatic improvement can be expected to be 88% immediately and up to 100% in the long term. 

Key words: chronic right iliac fossa pain, appendicitis, laparoscopy.

 

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