Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis

[Inflamatory indexes predictors of complicated acute apendicitis in children]

Background

Appendicitis is the main cause of acute surgical abdomen in pediatrics. Delay in the diagnosis implies serious consequences.

Objective

To know the utility of inflammation markers for predicting complicated acute appendicitis (CAA) in children.

Material and methods

Analytical cross-sectional retrolective study. We included patients from 3 to 17 years, with and without acute appendicitis (AA), who had complete blood count (CBC). Presurgical CBC, surgical findings and histopathologic results were recorded; group I, CAA; group II, uncomplicated acute appendicitis (UAA); and group III, without AA, with stratified analysis by age group.

Results

377 patients were included, 9 years of age (IQR 5-12.5), group I (n = 94), group II (n = 94) and group III (n = 189). Group I showed elevation in the values of Neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and Systemic immune inflammation (SII) index and lower levels for the Lymphocyte/monocyte ratio (LMR). For AA, in preeschoolers, NLR (sensitivity [S]: 0.85; specificity [E]: 0.98), PLR (S: 0.76; E: 0.85), SII (S: 0.92; E: 0.92) was observed; school children, NLR (S: 0.90; E: 0.96), PLR (S: 0.70: E: 0.86), SII (S: 0.91; E: 0.91); adolescents, NLR (S: 0.85; E: 0.97), PLR (S: 0.26; E: 0.95), SII (S: 0.86; E: 0.86); in CAA, S and E decreased. NLR, PLR, LMR and SII were associated with AA in all ages; PLR and SII in preschoolers, LMR in school children were associated with CAA.

Conclusion

NLR, PLR, LMR and SII are predictors of AA in pediatric age, and for AAC, PLR and SII in preschoolers and LMR in school children.

Acute Appendicitis with Appendicolith and its Complication and Management: A Case Report

Acute appendicitis is a common cause of acute abdominal pain requiring urgent surgery. Despite characteristic clinical signs, diagnosis can be challenging, leading to unnecessary appendectomies. This case report focuses on a 34-year-old male with escalating right lower quadrant abdominal pain. Imaging revealed acute appendicitis with a substantial appendicolith. Surgical intervention involved a open appendectomy with possible ileocecal resection due to cecal inflamation. Surgical findings indicated successful resection, and the patient recovered without complications. While urgent appendectomy is the norm, conservative approaches are gaining traction for peri-appendiceal abscesses. Interval appendectomy post-conservative treatment is a debated strategy. Management decisions are influenced by patient factors and disease severity. Future research is needed to establish standardized treatment protocols for complicated appendicitis. The case illustrates the evolving landscape of acute appendicitis management.