Introduction: Identification and promotion of diagnostic methods has been a continuous effort to reduce disease and its complications and reduce costs associated with treatment. Despite all these efforts and improving our knowledge of diseases and diagnostic tools, pediatric Appendicitis remains part of the diagnostic challenge in the surgical field. The aim of this is to compare the two diagnostic criteria of Appendicitis (Children's Appendicitis Score [PAS] Versus Pediatric Appendicitis Score [CAS]) and evaluation of the diagnostic features of them. Methods: A retrospective cohort study was conducted on all children admitted to the hospital's emergency center with a possible diagnosis of Appendicitis (270 patients) during 2018 and 2019 at Tabriz Pediatric Hospital. Based on the clinical examinations and para-clinical findings some of the patients were underwent the surgical intervention (220 cases) and some discharged and followed up for a period of 2 and 4 weeks later (50 cases). The data were analyzed through SPSS ver. 16 software. Results: The results of the present study indicated that if CAS was associated with ultrasound, the specificity of these criteria would improve and could be more acceptable compared with the PAS. In addition, it was revealed that WBC≥ 11000, as well as PMN≥ 65% and guarding were very specific for diagnosis and complication of acute Appendicitis. There was a significant relationship between US findings and pathology reports (P<0. 05). Conclusion: In conclusion, the CAS criteria were more sensitive and the PAS was more specific in diagnosing pediatric acute Appendicitis.

Introduction: Acute Appendicitis in children is associated with morbidity and mortality due to late diagnosis. Several scoring systems, such as Alvarado and PAS have been developed to help diagnose acute Appendicitis in children to make the most accurate and prompt decision. The purpose of this study was to compare the efficacy and diagnostic value of these scoring systems. Materials and Methods: In this cross-sectional study, 130 children aged 5-14 with suspected acute Appendicitis were included. After the collection of demographic data, all patients were scored by Alvarado and PAS systems. The decision for surgery was made by a surgeon, independently of these scores. The diagnosis of acute Appendicitis was affirmed by surgical and pathologic findings. Results: Male: Female ratio was 1. 32: 1, and the average age of the patients were 9. 2± 2. 7 years. The mean Alvarado and PAS scores were higher in patients with positive pathologic findings. Neutrophilia >75% and RLQ tenderness had the highest relationship with the diagnosis of the disease. The diagnostic value of Alvarado was higher than PAS concerning the area under the ROC curve. The cutoff point of 7 was associated with a sensitivity of 74. 5% and specificity of 66. 7% for the Alvarado score, and a sensitivity of 58. 5% and specificity of 79. 2% for the PAS score. Conclusions: The results showed the high sensitivity of Alvarado and the high specificity of PAS. However, the sensitivity, specificity, PPV, and NPV of these criteria were not satisfactory for the confirmation of the diagnosis.

Recurrent Appendicitis is a rare event after appendectomies, but can be occurred when there is incomplete appendectomy. In this report a 14 y/o male patient is presented with abdominal abscess and cecal mass seven and nine months after appendectomy. Review of literature showed that this uncommon clinical situation may be found after laparoscopic appendectomy, but it is very rare after open appendectomy. Awareness of the existing condition helps to make early diagnosis and prompt treatment.    

Appendicitis after age 40 is unusual, and Appendicitis two days after laparoscopic hysterectomy is very rare and has not been reported to date. We describe a 44-year-old woman who had abdominal pain two days after laparoscopic hysterectomy. The pathology report indicated early Appendicitis and the pain disappeared after appendectomy. In our opinion, the cause of Appendicitis may have been related to the use of monopolar and bipolar coagulation during laparoscopic hysterectomy, although the coincidence of Appendicitis and laparoscopic surgery may be accidental.