Appendicolith and inflammatory burden in pediatric acute appendicitis: an independent association.

PURPOSE: This study aimed to evaluate the radiological characteristics of appendicoliths detected on preoperative imaging and to assess their association with demographic, clinical, laboratory, surgical, and postoperative outcomes in children with acute appendicitis.

METHODS

Data from 711 pediatric patients who underwent appendectomy for acute appendicitis between July 2019 and August 2024 were retrospectively analyzed. Patients were grouped according to the presence of appendicolith on preoperative imaging, and postoperative outcomes were compared.

RESULTS

Appendicolith was detected in 124 (17.4%) patients; age and gender distribution were similar between groups. The rate of perforated appendicitis was significantly higher in patients with appendicoliths (47.6% vs. 23.5%; p < 0.001). CRP and WBC levels were significantly higher in the presence of appendicoliths (p < 0.001 for both). Appendicolith presence was associated with increased drain requirement (29.8% vs. 13.5%; p < 0.001) and longer postoperative hospital stay (median 5 vs. 4 days; p < 0.001). In multivariable analysis, appendicolith presence remained independently associated with perforation (adjusted OR: 2.53, 95% CI: 1.51-4.25).

CONCLUSION

Appendicolith in pediatric acute appendicitis was associated with increased inflammatory burden and a higher likelihood of complicated disease. However, given the retrospective design, prospective studies are required to clarify its role in clinical decision-making.