title: Importance of diarrhea as a presenting symptom of appendicitis in very young children.
abstract: BACKGROUND
  Appendicitis is an uncommon diagnosis in very young children. It is frequently complicated by delays in diagnosis, perforation, and lengthy hospital stays.
  
  
  OBJECTIVE
  To review our recent experience with appendicitis among children younger than 3 years old, and to identify the independent predictors of a prolonged hospital stay.
  
  
  METHODS
  A retrospective case series review was performed on all children under age 3 who had an appendectomy for appendicitis between January 1983 and February 1994. Multiple regression analysis was used to identify the independent predictors of a prolonged hospital stay.
  
  
  RESULTS
  Sixty-three children were identified. Mean age was 2.2 years (range 11 to 35 months). The mean delay from onset of symptoms to presentation was 4.3 days. Fifty-seven percent were initially misdiagnosed. Diarrhea was reported in 33%. Perforation and/or gangrene were found in 84%. Perforation and/or gangrene at laparotomy and a history of diarrhea at presentation were independent predictors of a prolonged hospital stay.
  
  
  CONCLUSIONS
  Appendicitis in children under 3 years old is characterized by delays in diagnosis and perforation. A history of diarrhea is an important factor that confuses the diagnosis, prolongs the observation period, and delays appropriate therapy.
authors.affiliation: Division of Pediatric Surgery, University of Texas Medical School, Houston, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Horwitz
authors.forename: M
authors.initials: M
authors.lastname: Gursoy
authors.forename: T
authors.initials: T
authors.lastname: Jaksic
authors.forename: K P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000453:epidemiology; D007902:Length of Stay; D007958:Leukocyte Count; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors