FREQUENCY OF FECOLITH AS A CAUSE OF ACUTE APPENDICITIS IN CHILDREN AND ITS IMPACT ON DISEASE SEVERITY

Abstract

examine their association with patients age, duration of symptoms, disease severity and operative findings.

METHODOLOGY

This Cross-sectional study was conducted in the Department of Pediatric Surgery at the National Institute of Child Health (NICH) from October 2024 to March 2025 after IERB approval (61/2023). Patients aged from 1 to 15 years who presented to the emergency department and were clinically diagnosed with acute appendicitis based on history, physical examination, radiological findings were included. Patients referred after undergoing surgery elsewhere for postoperative complications were excluded from the study. The duration of symptoms was recorded and stratified into two categories. Intraoperative findings were recorded including the type and severity of appendicitis, classified as catarrhal, suppurative, gangrenous, or perforated.  All the details were collected on a structured proforma.

RESULTS

The study included 173 children with the diagnosis of acute appendicitis.39 (22.5%) had fecolith and 134 (77.5%) did not. In the study group of fecolith, 12.8% were belonged to the age of ≤5 years, 53.8% were in the age group of 6-10 years and 33.3% were in the age group of 11-14 years. In comparison the non-fecolith population disclosed that 6.7% were ≤5 years, 59.0% aged 6–10 years and 34.3% were 11–14 years. The difference in age distribution was not statistically significant (p=0.464). Symptom duration was longer in the fecolith group, 79.5% were > 24 hours vs. 70.9% > 24 hours in the non-fecolith group (p=0.288). A marked difference was noticed in ultrasound findings (p=0.0001); 71.8% of patients with fecolith had perforation appendicitis as compared to 33.6% of patients without fecolith. Operative findings also had strong correlation with fecolith (p=0.0001). Perforated appendicitis was determined in 79.5% of patients that were fecolith positive in contrast with 35.1% of patients that did not have fecolith present. The average of total leukocyte count was slightly higher in patients with fecolith (15.56 ± 3.14) than in those without fecolith (14.94 ± 4.12), but there was no significant difference (p=0.386).

CONCLUSION

This study demonstrated a strong association between the presence of fecolith and the severity of appendicitis predominantly in cases of perforation. Fecolith was significantly more frequent in severe cases such as perforated appendicitis while it was rarely observed in catarrhal appendicitis. It strengthened fecolith role as a key factor in disease progression of appendicitis.