J. Rehbein1,2, A. Mowrer1,2, J. Esparaz1,3, R. Nierstedt2, S. Chakraborty2, K. Zumpf2, R. Pearl1,2, C. Aprahamian1,2, P. Jeziorczak1,2 1University of Illinois College of Medicine at Peoria,General Surgery/Pediatric General Surgery,Peoria, IL, USA 2Children Hospital Of Illinois / OSF Saint Francis Medical Center,General Surgery/Pediatric General Surgery,Peoria, IL, USA 3The Children’s Hospital Of Alabama,Birmingham, AL, USA
Introduction:
With efforts to decrease the risks associated with ionizing radiation exposure, ultrasound has become the standard imaging modality for suspected appendicitis in children. Due to the rising rate of childhood obesity, a new diagnostic dilemma has arisen when evaluating suspected appendicitis in the obese pediatric population. The purpose of this study is twofold: to evaluate the rate of non-visualization of the appendix in obese versus non-obese children, and to suggest an observation period in the management of suspected appendicitis in this population. We hypothesize that due to a presumed lower visualization rate in obese children, short-term observation instead would minimize the low yield of ultrasound as well as the unnecessary ionizing radiation from CT scans.
Methods:
A retrospective chart review was performed of 626 children from January 2014 to December 2017. Inclusion criteria utilized was appendectomy status, appendicitis status, having received an ultrasound of the appendix, and recorded or calculable BMI. BMI of more than 30 was considered obese. Approximately 25% of the patients in the review were labeled as obese. The data was examined using the Fischer’s exact z-test (p<0.05 considered significant).
Results:
It was determined that 49.1% of the patients had a visualized appendix. Obese children had significantly higher non-visualization of the appendix (64.1%) when compared to nonobese children (46.6%). It was found that 19.6% of patients receiving an ultrasound of the appendix underwent an appendectomy thereafter.
Conclusion:
This data demonstrates a difference does exist in visualization of the appendix when comparing obese and non-obese children. Based on this conclusion, a separate treatment approach should be considered with this population, including potential observation with repeat clinical examination by a pediatric surgeon rather than obtaining an abdominal ultrasound with limited clinical significance. As childhood obesity has become an epidemic, more information is necessary in developing a standard of care in the diagnostic recommendations of appendicitis management in the obese pediatric patient. Pediatric surgeons should be engaged early in the clinical evaluation to minimize potentially unnecessary studies.
