{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:02:17Z","timestamp":1792083737215,"version":"4.4.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,3,19]],"date-time":"2020-03-19T00:00:00Z","timestamp":1584576000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The aim of this study is the evaluation of clinical signs and outcomes of treatment in children under five years of age who underwent appendectomy because of acute appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>From January 2009 until December 2018, 90 patients (54 boys and 36 girls) younger than five years of age, treated with appendectomy because of acute appendicitis, were included in this study. Patients were divided into two groups, depending on the intra-operative finding of non-perforated (Group I; n\u2009=\u200932) or perforated (Group II; n\u2009=\u200958) appendicitis. The groups were compared regarding demographic, clinical, and laboratory data and outcomes of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 1687 appendectomies in this period, 90 (5.3%) of them were performed in patients aged five years or younger. There were 58 (64.4%) patients with perforated appendix. Positive correlation between the rate of perforation and the age of patients was found. Perforation rates were significantly higher in younger patients (100%, &lt;1 year; 100%, 1\u20132\u2009y; 83.3%, 2\u20133\u2009y; 71.4%, 3\u20134\u2009y; 78.6%, 4\u20135\u2009y, and 47.3%, 5\u2009y) (p\u2009=\u20090.037). Vomiting and diarrhea were found more commonly in the group of perforated appendix (p\u2009&lt;\u20090.002, p\u2009&lt;\u20090.001), while constipation was found more often in the patients whose appendix was not perforated (p\u2009&lt;\u20090.001). The median duration of symptoms (48\u2009h vs. 16\u2009h; p\u2009&lt;\u20090.001) and median duration of hospitalization (7.5 d vs. 5 d; p\u2009&lt;\u20090.001) were notably longer for the group of patients with perforated than the group of patients with non-perforated appendix. All complications occurred in the group of perforated appendix with total incidence of 4.4%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The clinical presentation of acute appendicitis for children aged five years or younger is often unusual, and establishing the proper diagnosis is often delayed. Patient age is tied closely to the stage of acute appendicitis, so the youngest patients present with more advanced stages of disease and are at greater risk of perforation. Acute appendicitis should be considered in all cases where a child is having abdominal pain, fever, and diarrhea, which has been shown to be present significantly more often in children with perforated appendix.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/sur.2019.175","type":"journal-article","created":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T16:10:34Z","timestamp":1571242234000},"page":"239-245","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":73,"title":["Acute Appendicitis in Children Younger than Five Years of Age: Diagnostic Challenge for Pediatric Surgeons"],"prefix":"10.1177","volume":"21","author":[{"given":"Zenon","family":"Pogoreli\u0107","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital of Split, Split, Croatia."},{"name":"University of Split, School of Medicine, Split, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josipa","family":"Domjanovi\u0107","sequence":"additional","affiliation":[{"name":"University of Split, School of Medicine, Split, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miro","family":"Juki\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital of Split, Split, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Poklepovi\u0107 Peri\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Research in Biomedicine and Health, University of Split, School of Medicine, Split, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,3,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.10.003"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v4.i2.19"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2019.025"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000375"},{"key":"e_1_3_2_6_2","first-page":"e2347","article-title":"Acute appendicitis in young children: A persistent diagnostic challenge for clinicians","volume":"10","author":"Hamid KA","year":"2018","unstructured":"Hamid KA, , Mohamed MA, , Salih A. 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Identifying signs, symptoms, laboratory and imaging parameters for an early diagnosis","volume":"16","author":"Garc\u00eda Cami\u00f1o E","year":"2014","unstructured":"Garc\u00eda Cami\u00f1o E, , Campillo L\u00f3pez F, , Delgado D\u00edez B, et al. Appendicitis in children under four years. Identifying signs, symptoms, laboratory and imaging parameters for an early diagnosis. Rev Pediatr Aten Primaria, 2014; 16:213\u2013218.","journal-title":"Rev Pediatr Aten Primaria"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-017-0335-2"},{"key":"e_1_3_2_15_2","first-page":"41","article-title":"Inflamed appendix: a diagnostic problem in children younger than 3 years of age","volume":"38","author":"Gougoudi E","year":"2011","unstructured":"Gougoudi E, , Rahmani E, , Filippopoulos A, et al. Inflamed appendix: a diagnostic problem in children younger than 3 years of age. 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