الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is almost common during later childhood and
early adult life. In developing countries, the incidence of appendicitis now appears to be increasing. Quick and accurate diagnosis of acute appendicitis is still a major problem, so every attempt should be made to increase diagnostic accuracy. The aim of this work is to evaluate some immunological aspects in
children suffering from appendicitis before and after appendicectomy, to
correlate immunologic status with the degree of the disease and to evaluate
the role of immunological parameters in the diagnosis of appendicitis.
One hundred patients of both sexes with age range of 7-15 years
were studied. All showed clinical manifestations of acute appendicitis and
were going to be operated upon for appendicectomy. Twenty normal
healthy volunteer children, matching sex and age range, were studied as a
control group.
This study was carried out at Zagazig University Hospital and
Zagazig general Hospital.
The patients, depending on histopathological examination of the
excised appendices were classified into 3 groups; perforated appendicitis
group, non-perforated appendicitis group and normal appendix group.
All subjects were subjected to the following:
1) Detailed history taking with special attention to age, sex, abdominal
pain, fever, anorexia, nausea and vomiting.
2) A thorough clinical examination with special attention to : temperature,
pulse, abdominal tenderness and abdominal rigidity.
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Summary and Conclusion
Blood samples were taken from operated patients (preoperativly and
7 days postoperatively), and control group for assessment of the following:
- Total and differential leukocytic counts (WEC and Neutrophil %)
-ESR
-CRP
- 0.-1- antirypsin
-C3
- IgG, IgM,IgA
- phagocytic activity.
The following was found:
1- There was a relatively high negative appendicectomy rate in children.
2- Age and sex can not differentiate significantly between positive and
negative cases.
3- History of abdominal pain was the most common complaint and
tenderness was the most constant sign.
4- Temperature showed highly significant difference but can not be used as
a diagnostic aid.
5- The history and physical findings were not particularly helpful III
distinguishing acute appendicitis from the negative group.
6- Most of the negative appendicectomies were done within the first day of
abdominal pain.
7- Total and differential white blood cell counts, (WEC and Neutrophil%),
ESR, CRP and C3 provided good indication and positive correlation
with acute appendicitis and showed respectable diagnostic values.
8- a-I-antitrypsin, IgM, IgG, IgA and phagocytic activity could not
provide valuable relationship with acute appendicitis, and also did not
show significant depression reflecting the general immunological status
of the studied children.
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SUmmary and Conclusion
Conclusion and Rocommendtion
• The negative appendicectomy rate is in need for proper estimation and
evaluation. Histopathological examination for every excised appendix,
may help, and wiII lead to improve the accuracy of diagnosis.
• Diagnosis of acute appendicitis in children, based on history and clinical
findings only, was lU1reliable.Using laboratory tests is mandatory.
• Active observation with close monitoring and repeated examination, and
laboratory test may lead to decrease the rate of negative
appendicectomy without increasing the rate of perforation.
• CBC, neutrophil%, CRP, and C3 were good indicators for acute
appendicits in children with respectable diagnostic values but with
combination of two or more of these parameters, the diagnostic values
and accuracy showed significant improvement, and the recommended
combination was WBC (>13.0x109/L) and CRP (>O.6mgldl) which
needs more research to be evaluated in diagnosing suspected cases of
acute appendicitis in children.