비전형적인 급성충수염의 복부 전산화 단층촬영과 임상 소견의 비교

박경혜,이강현,김윤권,원호경,김선휴,장요수,김현,황성오,장용수 대한응급의학회 2006 大韓應急醫學會誌 Vol.17 No.4

Comparison of Abdominal ComputerizedTomography and Clinical Findings inAtypical AppendicitisKyung Hye Park, M.D., Kang Hyun Lee, M.D., YunKwon Kim, M.D., Ho Kyong Won, M.D., Seon HyuKim, M.D., Yong Soo Jang, M.D., Hyun Kim, M.D.,Sung Oh Hwang, M.D. Purpose: The frequency of computerized tomography (CT)for diagnosing of atypical acute appendicitis, as ordered byemergency physicians, was noted. According to abdominalCT findings, the severity of acute appendicitis is divided intosix grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findingsof atypical acute appendicitis have a relation to the gradingof abdominal CT scans is unknown. This study was performedto evaluate the correlation between CT grades andsymptoms, signs and operative and pathologic findings ofatypical acute appendicitis. Methods: This study included 412 patients who wereadmitted and underwent an appendectomy from January2004 to June 2005. An abdominal and pelvic CT scan wasperformed in 114 patients who had atypical presentations inthe emergency room. The abdominal and pelvic CT scaleswere correlated with clinical signs, laboratory findings, andpathology reports. The CT scale for appendicitis is a sixgradescale from normal (grade 0) to periappendicealabscess (grade 5). Results: Sixty-six patients were male and 48 were female,and the mean age was 50.7±22.0 years old. On theabdominal CT, grade 0 (normal) was 3 patients (2.6%),grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis)17 (14.8%), grade 3 (appendicitis with periappendicitis)47 (40.9%), grade 4 (appendicitis with rupture) 30(26.1%), and grade 5 (complicated appendicitis) 12(10.4%). There was no significant difference between CTgrades and either local tenderness or rebound tendernessin the right lower quadrant abdomen (p>0.296). Howeverincreased body temperature correlated with higher CTgrades (p=0.01). There were significant differences in theneutrophil count (p<0.001), but not the white blood cellcount (p=0.493). The severity of pathology of acute appendicitiscorrelated with the CT grade (R=0.468, p=0.004). Conclusion: There was no significant correlation of localand rebound tenderness on right lower quadrant abdomenand of white blood cell count with CT grading in appendicitis,but there was a high correlation of body temperatureand of neutrophil counts with the CT grades of appendicitisfor patients with atypical appendicitis. The CT grades ofappendicitis also correlated with the pathology.

급성 충수돌기염의 조기 진단을 위한 초음파검사의 의의

오병연,임경수,이영주,김원,최옥경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. Methods: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gently. When the blind loop was found at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-appendiceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. Results: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by Us, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tendemess on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tendemess were observed for 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. Conclusions: In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an accurate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal CT scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.

The Value of Sonographic Evaluation of the Appendix in Patient with Pelvic Inflammatory Disease: Correlation with CT, clinical, and Pathological Findings

한훈,장경미,김민정,전의용,이관섭,고성혜,민광선 대한초음파의학회 2009 ULTRASONOGRAPHY Vol.28 No.2

Purpose: To assess the sonographic evaluation of the appendix in patients with pelvic inflammatory disease (PID) using CT, clinical, and pathological comparisons. Materials and Methods: During a three-year period, 51 patients with PID underwent appendix US and abdomino-pelvic CT. The findings of appendix on US were classified into three categories (normal appendix, normal appendix with inflamed periappendiceal fat, and acute appendicitis). Based on the CT analysis, the condition of the appendix was classified into five categories, namely (‘normal’, ‘probably normal’, ‘equivocal CT findings for diagnosis of appendicitis’, ‘probable appendicitis’, ‘definite appendicitis’). The CT and US results were then correlate with clinical and pathological findings. Results: Of 21 patients with definite or probable appendicitis as shown by CT analysis, US demonstrated normal appendix in 10 patients (48%), normal appendix with inflamed periappendiceal fat in 10 patients (48%), and primary appendicitis in the remaining patient (4%). Of 25 patients with normal or probably normal appendix as shown by CT analysis, US demonstrated normal appendix in 24 patients (96%), and primary appendicitis in the remaining patient (4%). The two patients with primary appendicitis, as shown by US, underwent appendectomy and pathological studies revealed primary appendicitis. Conclusion: A sonographic evaluation of the appendix in patients with PID improved the diagnostic accuracy for primary appendicitis. Purpose: To assess the sonographic evaluation of the appendix in patients with pelvic inflammatory disease (PID) using CT, clinical, and pathological comparisons. Materials and Methods: During a three-year period, 51 patients with PID underwent appendix US and abdomino-pelvic CT. The findings of appendix on US were classified into three categories (normal appendix, normal appendix with inflamed periappendiceal fat, and acute appendicitis). Based on the CT analysis, the condition of the appendix was classified into five categories, namely (‘normal’, ‘probably normal’, ‘equivocal CT findings for diagnosis of appendicitis’, ‘probable appendicitis’, ‘definite appendicitis’). The CT and US results were then correlate with clinical and pathological findings. Results: Of 21 patients with definite or probable appendicitis as shown by CT analysis, US demonstrated normal appendix in 10 patients (48%), normal appendix with inflamed periappendiceal fat in 10 patients (48%), and primary appendicitis in the remaining patient (4%). Of 25 patients with normal or probably normal appendix as shown by CT analysis, US demonstrated normal appendix in 24 patients (96%), and primary appendicitis in the remaining patient (4%). The two patients with primary appendicitis, as shown by US, underwent appendectomy and pathological studies revealed primary appendicitis. Conclusion: A sonographic evaluation of the appendix in patients with PID improved the diagnostic accuracy for primary appendicitis.

소아급성 비천공성과 천공성 충수염의 초음파 소견

배준기 대한영상의학회 1996 대한영상의학회지 Vol.34 No.5

Purpose: To analyse and interpret different sonographic findings in acute nonperforated and appendicitis.Materials and Methods: In 46 cases of acute appendicitis in children(26 girls, 20 boys) proven by surgery, sonographic findings were reviewed retrospectively. The findings of nonperforated and perforated appendicitis were analysed, focusing on the size, shape and echogenicity of the appendix, echo patterns of periappendiceal abscesses, mesenteric lymphadenopathy, and the prevalence of appendicolith. Results: A noncompressible distended appendix was present in 18 of 21 patients with nonperforated appendicitis and in 13 of 25 patients with perforation. In 18 patients with nonperforated appendicitis, the average diameter of distended appendix was 8.6mm;target appearance was noted in 16 patients and loss of echogenic submucosa in two. In 13 patients with perforated appendicitis, the average diameter of appendix was 9.1 mm;target appearance was noted in four patientsand loss of echogenic submucosa in nine. Periappendiceal abscesses were present in 21 of 25 cases of perforated appendicitis, and the echogenicity of abscesses was mixed in 12 patients, hypoechogenic in eight, and hyperechogenic in one. Mesenteric lymphadenopathy was present in two of 21 patients with nonperforated appendicitis and in four of 25 with perforation. Appendicolith was detected on sonography in three of 25 patients with perforated appendicitis, but was found in seven patients during surgery. One patients with perforated appendicitis also had right side hydronephrosis. Sonographically false-negative results were obtained in six cases. Conclusion : A sonographic examination was useful to differenciate perforated and nonperforated appendicitis in children. Loss of echogenic submucosa in the distended appendix and periappendiceal abscess formation were important findings in diagnosis of perforated appendicitis.

Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis

김태형,조병선,정재학,이문수,장제호,김창남 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.5

Purpose: Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis. Methods: A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis. Results: The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction’s diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant. Conclusion: Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Clinical course in children with equivocal appendicitis on computed tomography: a retrospective cohort study

Hee-Beom Yang*,Han-Byol Song*,Ji-Won Han,Joong Kee Youn,Dayoung Ko,Young Jin Ryu,Ji Young Kim,Hyun-Young Kim 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.104 No.1

Purpose: Appendectomy is one of the most common surgeries in children. Although various radiological examinations are performed, they do not always reveal a definitive diagnosis of appendicitis. This study aimed to investigate the clinical course of equivocal appendicitis, identify the factors associated with appendectomy, and suggest appropriate management for these patients. Methods: Patients younger than 19 years who visited Seoul National University Bundang Hospital with a differential diagnosis of appendicitis from January 2013 to December 2017 were included. All participants conducted ‘appendiceal CT’ with a scoring scale of 1–5. The higher the score, the higher the likelihood of a radiologic diagnosis of appendicitis. We defined the appendicitis CT score of 2–4 as equivocal appendicitis (n = 143). Medical records were reviewed retrospectively for demographics, further examination as abdominal ultrasonography, and appendectomy status (yes or no). The mean follow-up period was 15.6 ± 71 days. Results: Equivocal appendicitis accounted for 16.7%. Additional ultrasonography test was performed in 24.5% (35 of 143). In total, 34 patients (23.8%) underwent appendectomy. Among the patients with appendiceal CT scores 2, 3, and 4, 4.9%, 50.0%, and 87.5% underwent appendectomy, respectively. Higher WBC count, higher appendicitis CT score, and readmission were significantly associated with appendectomy in patients with equivocal appendicitis. Conclusion: Higher appendicitis CT score and WBC level were positively associated with appendectomy. Careful observation can be a treatment option in appendicitis CT score 2 or 3 groups. Appendectomy is the first-line treatment for patients with appendicitis score 4. Additional ultrasonography test is advisable to determine treatment modality for equivocal appendicitis.

소아 충수염의 복강경충수절제술 및 개복충수절제술의 비교

이세경,이철구,서정민,이석구,Lee, Se-Kyung,Lee, Cheol-Gu,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2007 소아외과 Vol.13 No.1

Pediatric laparoscopic appendectomy is controversial particularly in complicated appendicitis. We evaluated the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) in simple appendicitis and complicated appendicitis respectively. Since June 2004, initial LA has been our policy in all appendicitis including complicated ones. A total of 160 patients were included in this study, consisting of 80 OA (August 2001 - August 2003) and 80 LA (June 2004 - June 2006). We compared the operating time, the length of hospital stay, the length of antibiotics use, and the postoperative complications between LA and OA. In simple appendicitis (73), there were no differences between LA and OA. However in the 87 patients with complicated appendicitis, the operating time was longer in LA (64.8 min vs. 50.2 min) but the length of hospital stay was shorter in LA than OA (8.5 days vs. 9.6 days). There was one complication in simple appendicitis group and six in complicated appendicitis group (3 cases in LA, 3 cases in OA). There was no difference in the results of LA versus OA in simple appendicitis. Therefore for simple appendicitis, LA is recommended in consideration of the cosmetic effect (fewer scar). In complicated appendicitis, early discharge was an advantage and there were no differences in complications in LA despite a longer operative time. So we conclude LA can be considered as the first choice of treatment for all pediatric appendicitis including complicated appendicitis. To confirm our impressions, more well controlled randomized prospective studied need to be done.

LETTER TO THE EDITOR : Cytomegalovirus appendicitis with concurrent bacteremia after chemotherapy for acute leukemia

( Min Jung Cho ),( Jong Min Lee ),( Joo Yeun Hu ),( Jung Woo Lee ),( Sung Yeon Cho ),( Dong Gun Lee ),( Seok Lee ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.5

Cytomegalovirus (CMV) remains one of the most common infectious complications of allogeneic hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT). There have been many reports of CMV infection and/or disease in transplantation recipients and patients with AIDS. The risk of CMV disease occurring with chemotherapy has gradually increased with the use of more intensive chemotherapy in patients with hematologic malignancies [1]. In the non-allogeneic HSCT setting such as autologous HSCT or immunosuppressive therapy, including fludarabin, high-dose cyclophosphamide and steroids, and granulocyte infusions from unscreened donors are considered predisposing factors for CMV disease [1]. The lung and gastrointestinal tract are the major targets for CMV disease, and it can present throughout the entire intestine. Nevertheless, CMV appendicitis is exceedingly rare, and its clinical course and treatment are not well characterized. Only a few cases of CMV appendicitis have been reported in kidney transplantation recipients or patients with AIDS. We report a case of CMV appendicitis with concurrent bacteremia after consolidation chemotherapy for acute lymphoblastic leukemia. A 40-year-old male with precursor B-cell acute lymphoblastic leukemia developed neutropenic fever and abdominal pain 9 days after starting consolidation chemotherapy (highdose cytarabine 2 g/m2, every 12 hours, days 1 to 5; mitoxantrone 12 mg/m2, days 1 to 2). The patient had a history of invasive pulmonary aspergillosis (IPA) and had been treated with itraconazole (400 mg/day) for more than 2 months. IPA was diagnosed according to the revised def inition from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group. IPA had developed during the third cycle of induction chemotherapy, and serial regression of the lung lesion was evident. Empirical antibiotic therapy with cefepime (4 g/day) and isepamicin (400 mg/day) was started. On day 13 after starting chemotherapy, the patient`s vital signs were as follows: blood pressure 120/70 mmHg, pulse rate 80 beats per minute, body temperature 37.7°C. Abdominal examination revealed direct tenderness and rebound tenderness in the right lower quadrant. Chest examination revealed clear breathing sounds. Laboratory results revealed a white blood cell count of 10/mm3 (neutrophils 0%, lymphocytes 0%), hemoglobin 8.4 g/dL, platelets 26,000/mm3, aspartate aminotransferase/alanine aminotransferase 24/39 IU/ L, total/direct bilirubin 0.94/0.24 mg/dL, blood urea nitrogen/creatinine 12.8/0.67 mg/dL, total protein/albumin 5.3/3.3 g/dL, and C-reactive protein 19.78 mg/dL. The antibiotic therapy was changed to piperacillin-tazobactam (piperacillin 12 g/day, tazobactam 1.5 g/day) to broaden the coverage of anaerobic bacteria. Bacterial growth was detected in blood culture and identified as extended spectrum β-lactamase (ESBL)-producing Escherichia coli. Piperacillin-tazobactam therapy was withdrawn, and meropenem (3 g/day) was initiated. An abdominal computed tomography (CT) scan was performed and revealed appendiceal wall thickening with a 2.4 × 2.1-cm hypodense lesion, suggesting appendicitis with periappendiceal abscess formation and microperforation (Fig. 1). There was no definitive bowel wall thickening at the terminal ileum and cecum. However, the patient was unable to tolerate surgical intervention due to persistent pancytopenia. Despite 6 days of antibiotic therapy the patient`s fever was sustained with aggravation of his abdominal pain. On day 20, the patient`s vital signs were: blood pressure 80/50 mmHg, pulse rate 170 beats per minute, and body temperature 38.6°C. The patient subsequently developed septic shock. Teicoplanin (400 mg/day after the initial loading dose) was administered in addition to meropenem. A follow-up abdominal CT scan revealed hemoperitoneum and progression of appendicitis, with developed edematous wall thickening of the terminal ileum, cecum, and ascending colon. Superior mesenteric arteriography showed extravasation of a branch of the ileocolic artery, and embolization was performed. The patient received a random donor granulocyte transfusion on day 23 and his absolute neutrophil count (ANC) increased from 450/mm3 to 4,370/mm3 (Fig. 2). However, his absolute lymphocyte count decreased from 300/ mm3 to 0/mm3. On day 35, percutaneous drainage of the periappendiceal abscess was performed under the guidance of ultrasonography. Enterococcus faecium and ESBL-producing E. coli were identified in bacterial culture of the drained abscess. On day 39 the patient`s ANC was 1,390/mm3 and platelet count was 118,000/ mm3 after transfusion, and he underwent right hemicolectomy and appendectomy. The appendiceal pathology revealed acute suppurative appendicitis, serositis, and cecal perforation. Hematoxylin and eosin (H&E) and CMV-specific immunohistochemical staining of the appendiceal specimen revealed inclusion bodies at the area of acute inflammation, consistent with CMV infection (Fig. 3). Pathology of the ascending colon revealed submucosal hemorrhage and edema without evidence of CMV infection. Serum CMV real-time quantitative polymerase chain reaction (RT-PCR; Roche Diagnostics, Mannheim, Germany) showed a positive result of 43,438 copies/mL on day 49 and 497,533 copies/mL on day 52. The patient had a fever of ~38.0°C at that time. No evidence of CMV retinitis was observed by an ophthalmologist. After surgical resection and administration of ganciclovir (5 mg/kg intravenous, every 12 hours) for 5 days, the fever subsided. However, the patient experienced adverse effects to the ganciclovir treatment, including neutropenia, nausea, and vomiting, and was subsequently switched to foscarnet therapy (60 mg/kg intravenous, every 12 hours). CMV DNAemia by PCR revealed negative conversion after 24 days of antiviral therapy with ganciclovir and foscarnet. On day 79, the patient was discharged without complications. CMV disease development is rare after chemotherapy other than HSCT; however, the risk of CMV disease is increasing with the use of chemotherapies that suppress cell-mediated immunity [1]. Our patient had acute lymphoblastic leukemia and showed persistent lymphopenia as well as neutropenia. Additionally, his absolute lymphocyte count continued to be < 500/ mm3 throughout hospitalization. These factors appear to have contributed to development of CMV disease. While granulocyte transfusion from a random donor could be considered a risk factor, the patient`s right lower quadrant pain and sustained fever presented prior to the granulocyte infusion. In this case, it is unclear whether the granulocyte infusion was a predisposing factor for development of CMV appendicitis. There have been cases of CMV pneumonia associated with chemotherapy reported in Korea [2,3]. However, to our knowledge this is the first report of appendicitis due to CMV infection after chemotherapy. We also detected E. coli and E. faecium in blood and/ or the appendiceal abscess simultaneously. In this patient, CMV appendicitis may have been accompanied by neutropenic enterocolitis. The general problem of reporting copathogens together with CMV in CMV disease is well known. In this case, E. coli and/or E. faecium appeared to be the true pathogens while CMV was considered an ‘innocent bystander.’ However, CMV disease is defined by identification of clinical symptoms with demonstration of CMV infection (by culture, histopathologic testing, or immunohistochemical staining) in a biopsy specimen. The diagnosis of CMV disease in this case was confirmed by H&E and CMV-specific immunohistochemical staining of the appendiceal specimen, revealing inclusion bodies at the area of acute inflammation. The diagnosis was also supported by the identification of CMV DNA in the patient`s blood using RT-PCR. Blood-based monitoring for CMV by antigenemia assay or detection of viral DNA or RNA has been used for patients who have undergone allogeneic HSCT or SOT [4,5]. However, whether the detection of CMV in blood is a predictive factor for CMV disease in a non-allogeneic HSCT setting has not been demonstrated [1]. While screening of asymptomatic chemotherapy patients may not be considered cost-effective, the significance of viral pathogen detection in symptomatic leukemia patients after chemotherapy.even in the presence of other pathogens.is underscored by this case. Currently, the def initions of CMV infection and disease are focused on the transplant recipients. However, this case demonstrates that not only HSCT recipients or AIDS patients but also acute leukemia patients can develop CMV disease during treatment with chemotherapy. Physicians should consider the possibility of CMV disease, especially when the patient presents with suppressed cell-mediated immunity, such as prolonged lymphopenia. The development of recommendations for the diagnosis and treatment of CMV disease in leukemia patients who did not receive HSCT would complement existing guidelines.

The diagnostic values of preoperative laboratory markers in children with complicated appendicitis

Hany Noh,Sei-Jin Chang,Airi Han 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.4

Purpose: Accurate diagnosis and optimal management of acute appendicitis, despite being the most common surgical emergency encountered in emergency departments, is often delayed in pediatric patients due to nonspecific symptoms and communication barriers, often leading to more complicated cases. The aim of this study is to investigate the diagnostic significance of common laboratory markers. Methods: A total of 421 patients aged 15 and younger underwent surgical treatment for acute appendicitis. We conducted a retrospective analysis for white blood cell (WBC), C-reactive protein (CRP) and bilirubin. All patients were classified into simple or complicated appendicitis groups based on postoperative histology. Results: The mean age of the patients in the complicated appendicitis group was younger than that in the simple group (P = 0.005). WBC, CRP and bilirubin levels were significantly higher in the complicated appendicitis group (P < 0.001, <0.001, 0.002). The relative risk for complicated appendicitis was calculated using age, WBC, CRP and bilirubin. Elevated CRP levels were associated with the highest risk for complicated appendicitis (hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.38 to 4.65) followed by WBC (HR, 2.42; 95% CI, 1.07 to 5.46) and bilirubin (HR, 2.04; 95% CI, 1.09 to 3.82). The most sensitive markers for diagnosing complicated appendicitis were WBC (95.2%) and CRP (86.3%). Bilirubin levels showed the highest specificity at 74.8%. Conclusion: The risk of complicated appendicitis was significantly higher in patients younger than 10 years old. Preoperative WBC, CRP and bilirubin have clinical value in diagnosing complicated appendicitis with a HR of 2.0 to 2.5. Our results suggest that the utilization of WBC, CRP, and bilirubin can assist in the diagnosis of complicated appendicitis in pediatric patients, allowing prompt diagnosis and optimal management.

소아기 급성충수염의 임상적 고찰

유재홍 최신의학사 1993 最新醫學 Vol.36 No.9