Laparoscopic appendectomy for recurrent right iliac fossa pain.

INTRODUCTION Unexplained recurrent right iliac fossa (RIF) pain is a frequent problem in children, especially in school age and adolescent. It is responsible for multiple hospital admission and conventional diagnostic studies fail to identify the cause in up to 90% of cases. The aim of this study has been to investigate the role of elective laparoscopic appendectomy in patients with RIF pain. MATHERIAL/METHODS A retrospective analysis of ninety-eight laparoscopic appendectomy from January 2008 and December 2010 was carried out. Fourteen children underwent elective appendectomy for recurrent RIF pain. This group was characterized by history of frequent episodes of RIF during the last months or three or more recurrent attacks of pain over one year. In all children, symptoms were severe enough to warrant repeated visits and hospitalization with significant impact on social life. Clinical exam, behavioral history, serological and instrumental investigations were not conclusive for diagnosis. Mean age was 13 years (range 8 to 16 years), 10 (67%) were female and the mean duration of symptoms was 6 months (range 2 to 10 months). Follow-up was 6-36 months (median 18 months) and outcome data were obtained by visits and interview by phone. RESULTS At laparoscopy, all appendix appeared normal or slightly inflamed but appendectomy and pathology exam was carried out. No other abnormalities or pathology were found at laparoscopy as possible cause of pain. There were not intra- or post-operative complications. Of the 14 patients studied, 13 (93%) had complete resolution of symptoms at follow-up. All the specimens, however, showed chronic inflammation with fibrosis, hyperplastic - follicular changes and mononuclear inflammatory infiltrate (lymphocytes and plasmacells). CONCLUSION Our study demonstrate that children with chronic RIF pain have pathology in the appendix and laparoscopy appendectomy is a valuable procedure for diagnosis and treatment even if the appendix seems macroscopically normal, when no other causes of pain are found, appendectomy should be done. Fibrosis and chronic inflammatory cells found at histology reports support the conditions of chronic appendicitis, which may presents as chronic or recurrent pain.