Clinical features and treatment outcomes in obese children with appendicitis

Background: Even developing countries are facing problems of childhood obesity. Diagnosis and treatment of appendicitis in obese children can sometimes be challenging. This study compared clinical features and treatment outcomes between non-obese and obese children clinically diagnosed as appendicitis. Methods: Children (0 15 years) diagnosed as appendicitis between 2007 and 2013 were reviewed. Children were categorized into non-obese and obese groups using weight for height (> 140.0% of ideal body weight) based on the data of the Ministry of Public Health. Demographic data, clinical data, and treatment outcome were studied. Comparisons between non-obese and obese children were carried out. SPSS was used for all statistical analyses. Data are expressed as mean  standard deviation. Results: There were 268 children (222 non-obese and 46 obese) pre-operatively diagnosed as appendicitis. All patients underwent open appendectomy. Body mass index (BMI) of non-obese children was 18.3  3.5 kg/m whereas BMI of obese children was 27.2  4.3 kg/m, (P < 0.0001). There was no difference in age between the 2 groups (non-obese vs. obese, 10.6  2.7 vs. 10.5  2.2 yr., P = 0.84). The majority of patients sought medical attention within 24 hours in both groups (67.0% vs. 76.0%, P = 0.23). Imaging studies (ultrasound or computed tomography) was used to confirm the diagnosis in 6.3%. There was no difference between non-obese and obese groups regarding operative time (71.3  26.4 vs. 77.9  28.1 min, P = 0.13), negative appendectomy rate (6.7% vs. 8.7%, P = 0.75), perforation rate (17.1% vs. 9.0%, P = 0.25), hospital stay (94  64 vs. 81  39 hr., P = 0.19) and wound infection (4.9% vs. 4.3%, P = 0.99). Conclusion: Approximately one-fifth of children undergone appendectomy were obese. Our data suggest that obesity might not be associated with increased difficulty in making the diagnosis of appendicitis in children. However, childhood obesity appears to be associated with potentially more difficult surgery, as the increase in operative times.