Pediatric Surgery International

, Volume 35, Issue 3, pp 335–340 | Cite as

Eosinophilia in pediatric uncomplicated appendicitis is a time stable pattern

  • Josephine ReismannEmail author
  • D. Schädlich
  • M. I. Minderjahn
  • K. Rothe
  • M. Reismann
Original Article



We have recently shown that uncomplicated phlegmonous appendicitis is characterized by independent inflammatory patterns based on significant eosinophilia in children aged 7–17 years. However, clinical decision-making based on inflammatory values is not easy, especially due to the dynamics of inflammation over time. The present study was performed to evaluate the basic distinguishability of the inflammatory entities by laboratory values over time based on an extended patient number with children aged 0–17 years.


All patients aged 0–17 years, who underwent appendectomy from January 2008 until June 2016, were retrospectively reviewed. Special attention was paid to cellular subpopulations within full blood counts within compartments of time (onset of symptoms – blood sampling): 0–12 , > 12–24 , > 24–36 , > 36–48 , > 48–72 , > 72 h.


1041 appendectomies were included in the study. The inflammatory course in patients with complicated appendicitis (n = 369) was characterized by continuously increased mean leukocytes, neutrophil and monocyte counts compared with patients with phlegmonous appendicitis (n = 489). In contrast, continuous relative eosinophilia was found in uncomplicated appendicitis within the inflammatory process. In cases of negative appendectomies (n = 183), again, distinct independent inflammatory patterns were found.


Eosinophilia is a constant and independent pattern in children with uncomplicated appendicitis, which, thus, can be distinguished throughout the inflammatory process.


Children Appendicitis Eosinophilia Time course 



No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Compliance with ethical standards

Conflict of interest

Josephine Reismann declares that she has no conflict of interest. Dag Schädlich declares that he has no conflict of interest. Maximiliane I. Minderjahn declares that she has no conflict of interest. Karin Rothe declares that she has no conflict of interest. Marc Reismann declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (No. EA2/169/18) and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925CrossRefGoogle Scholar
  2. 2.
    Pham XBD, Sullins VF, Kim DY, Range B, Kaji AH, de Virgilio CM, Lee SL (2016) Factors predictive of complicated appendicitis in children. J Surg Res 206:62–66CrossRefGoogle Scholar
  3. 3.
    Fallon SC, Kim ME, Hallmark CA, Carpenter JL, Eldin KW, Lopez ME (2015) Correlating surgical and pathological diagnoses in pediatric appendicitis. J Pediatr Surg 50:638–641CrossRefGoogle Scholar
  4. 4.
    Andersson M, Rubér M, Ekerfelt C, Björnsson Hallgren H, Olaison G, Andersson RE (2014) Can new inflammatory markers improve the diagnosis of acute appendicitis? World J Surg 38:2777–2783CrossRefGoogle Scholar
  5. 5.
    Bates MF, Khander A, Steigman SA, Tracy TF, Luks FI (2014) Use of white blood cell count and negative appendectomy rate. Pediatrics 133:e39–e44CrossRefGoogle Scholar
  6. 6.
    Lichtenstein C, Brenner T, Bardenheuer HJ, Weigand MA (2012) Predictors of survival in sepsis: what is the best inflammatory marker to measure. Curr Opin Infect Dis 25:328–336CrossRefGoogle Scholar
  7. 7.
    Minderjahn M, Schädlich D, Radtke J, Rothe K, Reismann M (2018) Phlegmonous appendicitis is characterized by eosinophilia in white blood cells counts. World J Ped 14:504–509CrossRefGoogle Scholar
  8. 8.
    Almström M, Svensson JF, Patkova B, Svenningsson A, Wester T (2017) In-hospital surgical delay does not increase the risk for perforated appendicitis in children. A single-center retrospective cohort study. Ann Surg 265:616–621CrossRefGoogle Scholar
  9. 9.
    Hanley JA, Mc Neil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36CrossRefGoogle Scholar
  10. 10.
    Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G (1994) Indications for operation in suspected appendicitis and incidence of perforation. BMJ 308:107–110CrossRefGoogle Scholar
  11. 11.
    Rubér M, Berg A, Ekerfelt C, Olaisson G, Andersson RE (2006) Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis. Clin Exp Immunol 143:117–124CrossRefGoogle Scholar
  12. 12.
    Rubér M, Andersson M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C (2010) Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery 147:366–372CrossRefGoogle Scholar
  13. 13.
    Thomas LL (1995) Basophil and eosinophil interactions in health and disease. Chem Immunol 61:186–207CrossRefGoogle Scholar
  14. 14.
    Aravindan KP (1997) Eosinophils in acute appendicitis: possible significance. Indian J Pathol Microbiol 40:491–498Google Scholar
  15. 15.
    Pecaric-Petkovic T, Didichenko SA, Kaempfer S, Spiegl N, Dahinden CA (2009) Human basophils and eosinophils are the direct target leucocytes of the novel IL-1 family member IL-33. Blood 113:1526–1534CrossRefGoogle Scholar
  16. 16.
    Annunziato F, Romagnani C, Romagnani S (2015) The 3 major types of innate and adaptive cell-mediated effector immunity. J Allergy Clin Immunol 135:626–635CrossRefGoogle Scholar
  17. 17.
    Gurien LA, Wyrick DL, Smith SD, Dassinger MS (2016) Optimal timing of appendectomy in the pediatric population. J Surg Res 202:126–131CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryCharité, Universitätsmedizin BerlinBerlinGermany

Personalised recommendations