WOFAPS 2025 8th World Congress of Pediatric Surgery

Hassan Mirza ¹, Syed Hussnain Sherazi ², Muhammad Osama Khan ², Javeria Javed ², Yusra Tariq ², Saleem Islam ¹, Aqil Soomro ¹, Saqib Qazi ¹

¹ Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
² Aga Khan University Karachi Pakistan

Purpose –

Complicated appendicitis is linked with higher morbidity, including infections, intra-abdominal collections, and prolonged hospitalization. Age, symptom duration, leucocytosis, neutrophilia, and CRP have been used as predictors of complicated appendicitis, with variable success. Hyponatremia has recently been proposed as a potential marker for complicated appendicitis. The study aims to assess our experience with hyponatremia at presentation and complicated appendicitis.

Methods -

A prospective observational study was conducted over a 6-month duration. All children < 18 years of age diagnosed with acute appendicitis were recruited using non-probability consecutive sampling after ethical approval. Patients were divided into two groups: Simple Appendicitis (Group A) and complicated appendicitis (Group B). Hyponatremia was defined as serum sodium <136 mmol/L. Patients with prior intravenous fluid administration or underlying metabolic/endocrine disorders were excluded.

Results –

70 patients were included, 36 (51.4%) had simple appendicitis, and 34 (48.6%) had complicated appendicitis. Patients with complicated appendicitis had a significantly longer mean duration of symptoms (2.9 ± 2.2 vs. 1.6 ± 1.2 days; p = 0.008) and hospital stay (2.7 ± 1.9 vs. 1.2 ± 0.6 days; p < 0.01) compared to simple appendicitis. Hyponatremia was present in 32 out of 34 patients (94.1%) with complicated appendicitis. The mean serum sodium level was significantly lower in the complicated appendicitis group (126.6 ± 4.34 mmol/L) than in the simple appendicitis group (136.6 ± 2.72 mmol/L; p < 0.01). A plasma sodium threshold of ≤136 mmol/L demonstrated a sensitivity of 93.5% and specificity of 51.9% for identifying complicated appendicitis, with an AUC of 0.898 and CI 95%.

Conclusion –

We noted that hyponatremia was a specific predictor of complicated appendicitis, and it can serve as a useful biochemical marker for early risk stratification.