Characterization of acute appendicitis in diabetic children

PurposeChildren with diabetes mellitus (DM) who develop acute appendicitis can present a diagnostic and clinical challenge. No studies have examined this population since the advent of multiple dose insulin therapy, computed tomography, and laparoscopic surgery. We sought to characterize these children to identify their differences and how to best care for them.MethodsWe retrospectively examined the medical records of children with a preexisting diagnosis of DM treated for acute appendicitis. Values are presented as the mean ± the standard error of the mean, and Student's t-test was used for statistical comparison.ResultsWe identified 18 diabetic children treated for acute appendicitis, making this the largest series of its kind. These children had similar presentations compared to non-diabetics, with the exception of often presenting without fever (83.3% with an initial temperature < 38 C). All children developed significant postoperative hyperglycemia (average high 382 ± 18 mg/dL), and most had glycemic control for ≤ 50% of the hospitalization (14/18, 77.8%), but they otherwise had typical postoperative courses.ConclusionsDiabetic children with appendicitis are often afebrile at presentation and have serum glucose levels that are difficult to control. Collaboration with pediatric endocrinologists is needed to appropriately manage these children during their hospitalization.