Appendiceal location in Japanese children with acute appendicitis: pelvic predominance and diagnostic and operative implications.

PURPOSE: Appendiceal location may affect the diagnosis and surgical management of acute appendicitis. However, pediatric-specific data remain limited. This study evaluated appendiceal location in Japanese children with acute appendicitis and examined its clinical implications.

METHODS

In total, 105 pediatric patients who underwent laparoscopic or laparoscopic-assisted appendectomy between January 2015 and March 2024 were retrospectively reviewed. Appendiceal location was classified using a modified Wakeley classification based on intraoperative laparoscopic findings. Clinical presentation, ultrasonographic identification rate, and surgical outcomes were compared among groups.

RESULTS

The pelvic position was the most common appendiceal location (51.4%), followed by the retrocecal position (20.0%). Approximately 87.6% of patients underwent ultrasonography. The retrocecal group had a significantly lower identification rate than the other location groups (61.1% vs. 85.1%, p = 0.041). The retrocecal group had a significantly longer surgical duration than the pelvic group (median: 90 vs. 58 min, p = 0.010). The clinical presentation and postoperative complications did not differ significantly among the groups.

CONCLUSION

In this cohort of Japanese children with acute appendicitis, the pelvic position was the most common appendiceal location. The retrocecal position was associated with lower ultrasonographic identification rates and a longer surgical duration, indicating greater diagnostic and technical challenges.