Clinical, laboratory and ultrasonographic criteria for reveaing inflammation of the appendix and its regression in children

Introduction. Because of the numerous studies on a possible regression of inflammation in the cecum appendix, the question of finding reliable criteria for preoperative verification of inflammation and of assessing its dynamics in children is relevant.
Material and methods. In January 2017 – December 2021, case-histories of 92 children aged from 3 to 18 years – (Me (age median) = 12; Q₁ (lower quartile) = 9; Q₂ (upper quartile) = 14.5 – were analyzed in the Yaroslavl Children's Clinical Hospital. The researchers assessed diagnostic and management algorithms. All children had a high risk of appendicitis (PAS (Pediatrics appendicitis score) ≥ 6 points) because of changes in the appendix and findings of ultrasound examination, but due to the symptoms relief, no surgical interventions were performed.
Results. 78 (84.8%) children were prescribed antibacterial therapy. The median duration of symptom regression was 2 days (Q₁ = 1 day; Q₂ =4 days). On days 5–8 (Q₁–Q₂) (Me = 6 days), relief of all symptoms of the disease was recorded.
The average diameter dimensions of the vermiform process, by ultrasound findings at the initial examination, were 8.6 ± 1.47 (95% CI 8.31–8.92), wall thickness – 3.2 ± 0.39 (95% CI 3.12–3.28). After the symptom relief , these indicators were 6.3 ± 1.29 (95% CI 5.95–6.58) and 2.0 ± 0.63 (95% CI 1.18–1.88), respectively. The decrease in size was statistically significant (p < 0.001), signs regressed in parallel (r = 0.63; p < 0.0001).
95% CI lower limit of ultrasonographic parameters at the initial examination exceeded the threshold values indicating inflammatory changes (8 mm and 2.7 mm, respectively). After regression of the disease symptoms, 95% CI upper limit returned to the normal state.
Conclusion. The presented clinical observations may be considered as cases of appendix inflammation with regression. The selected clinical and ultrasonographic criteria can be used both for verifying inflammation and for assessing the regression of inflammatory process.