• Muhammad Umer Qureshi Department of Paediatric surgery,The children hospital, Pakistan institute of medical sciences, Islamabad
  • Asad Iqbal PIMS, Islamabad
  • Murad Habib PIMS Islamabad
  • Muhammad Umar Nisar Islamic international Medical College Trust, Islamabad
  • Afia Ayub CMH, Rawalpindi
  • Muhammad Amjad Chaudhary PIMS Islamabad
  • Sibghatullah Babar PIMS, Islamabad




Acute appendicitis, Complicated Appendicitis, Hyponatremia, Paediatric, uncomplicated Appendicitis


Background: The most frequent cause of paediatric acute abdomen is acute appendicitis. If acute appendicitis is not treated promptly, one third of cases progress to complicated appendicitis. Complicated appendicitis is associated with significant morbidity and its management protocol differs significantly from that of uncomplicated appendicitis. In this study, we assessed the relationship between serum sodium levels and complicated appendicitis. Methods: We conducted a prospective observational study from July to December 2020 at the Department of Neonatal and Paediatric Surgery, The Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, on a sample size of 140 patients who met inclusion and exclusion criteria. For this study, we divided the patients into two groups. Group 1 had uncomplicated appendicitis and Group 2 had complicated appendicitis. These findings were then compared to preoperative serum sodium (Na) levels. Results: The median serum sodium level in group 1 (uncomplicated appendicitis) was 137.81 mg/dl, while in group 2 it was 131.35 mg/dl (Complicated Appendicitis). The sensitivity and specificity of serum sodium levels at a cut-off point of less than 135 mg/dl were 84.80% and 89.40%, respectively. Conclusion: Hyponatremia is currently thought to be a new marker for differentiating between complicated and uncomplicated appendicitis. It is a low-cost, high-efficiency predictive marker for diagnosing and differentiating complicated appendicitis in children.

Author Biographies

Asad Iqbal, PIMS, Islamabad

Resident Paediatric Surgery

Murad Habib, PIMS Islamabad

Resident Paediatric Surgery

Muhammad Umar Nisar, Islamic international Medical College Trust, Islamabad

Senior Registrar Paediatric Surgery

Afia Ayub, CMH, Rawalpindi

Resident Plastic Surgery

Muhammad Amjad Chaudhary, PIMS Islamabad

Chair and Head of Neonatal Paediatric Surgery

Sibghatullah Babar, PIMS, Islamabad

House Surgeon, paediatric Surgery


Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(5):910–25.

Besli GE, Çetin M, Durakbaşa ÇU, Özkanlı Ş. Predictive value of serum sodium level in determining complicated appendicitis risk in children. Haydarpasa Numune Train Res Hosp Med J 2019;59(1):35–40.

Giannis D, Matenoglou E, Moris D. Hyponatremia as a marker of complicated appendicitis: A systematic review. Surgeon 2020;18(5):295–304.

Guaitoli E, Gallo G, Cardone E, Conti L, Famularo S, Formisano G, et al. Consensus statement of the italianpolispecialistic society of young surgeons (SPIGC): diagnosis and treatment of acute appendicitis. J Invest Surg 2021;34(10):1089–1103.

Berdon WE, Slovis TL. Where we are since ALARA and the series of articles on CT dose in children and risk of long-term cancers: what has changed? Pediatr Radiol 2002;32(10):699.

Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 2014;133(4):586–93.

Pogorelić Z, Domjanović J, Jukić M, PoklepovićPeričić T. Acute appendicitis in children younger than five years of age: diagnostic challenge for pediatric surgeons. Surg Infect (Larchmt) 2020;21(3):239–45.

Mohammed AA, Daghman NA, Aboud SM, Oshibi HO. The diagnostic value of C-reactive protein, white blood cell count and neutrophil percentage in childhood appendicitis. Saudi Med J 2004;25(9):1212–5.

Pham XB, Sullins VF, Kim DY, Range B, Kaji AH, de Virgilio CM, et al. Factors predictive of complicated appendicitis in children. J Surg Res 2016;206(1):62–6.

Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000;36(1):39–51.

Barrett ML, Hines AL, Andrews RM. Trends in Rates of Perforated Appendix, 2001–2010. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 [cited 2021 Aug]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK169006/

Bickell NA, Aufses Jr AH, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg 2006;202(3):401–6.

Pogorelić Z, Lukšić B, Ninčević S, Lukšić B, Polašek O. Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study. J Pediatr Surg 2021;56(10):1816–21.

Avanesov M, Wiese NJ, Karul M, Guerreiro H, Keller S, Busch P, et al. Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). Eur Radiol 2018;28(9):3601–10.

Yang J, Liu C, He Y, Cai Z. Laboratory Markers in the Prediction of Acute Perforated Appendicitis in Children. Emerg Med Int 2019;2019:4608053.

Zani A, Teague WJ, Clarke SA, Haddad MJ, Khurana S, Tsang T, et al. Can common serum biomarkers predict complicated appendicitis in children? Pediatr Surg Int 2017;33(7):799–805.

Lindestam U, Almström M, Jacks J, Malmquist P, Lönnqvist PA, Jensen BL, et al. Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study. Eur J Pediatr Surg 2020;30(4):350–6.