title: Acute appendicitis in preschoolers: a study of two different populations of children.
abstract: OBJECTIVE
  To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region.
  
  
  METHODS
  Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children) and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue.
  
  
  RESULTS
  Acute appendicitis of preschoolers developed more frequently in Muslims (39.4%) than in Christians (17.7%; p < 0.001). The lack of inside toilet facilities at home, overcrowded living conditions, living in rural areas, and the amount of appendix lymphoid tissue were significantly more frequent among the Muslim preschool children (p < 0.05), while there were no statistically significant differences between Muslim and Christian children with regard to gender, the family history of acute appendicitis, or the vegetable consumption (p > 0.05).
  
  
  CONCLUSIONS
  In our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.
authors.affiliation: Department of Pediatric Surgery, Alexandoupolis University Hospital, Democritus University of Thrace School of Medicine, Alexandroupolis 68100, Greece. sgardik@med.duth.gr
authors.forename: Stefanos
authors.initials: S
authors.lastname: Gardikis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Giatromanolaki
authors.forename: Katerina
authors.initials: K
authors.lastname: Kambouri
authors.forename: Gregorios
authors.initials: G
authors.lastname: Tripsianis
authors.forename: Efthimios
authors.initials: E
authors.lastname: Sivridis
authors.forename: George
authors.initials: G
authors.lastname: Vaos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000208:ethnology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002835:Christianity; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007514:Islam; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires