World Journal of Pediatrics

, Volume 14, Issue 5, pp 504–509 | Cite as

Phlegmonous appendicitis in children is characterized by eosinophilia in white blood cell counts

  • Maximiliane I. Minderjahn
  • Dag Schädlich
  • Josephine Radtke
  • Karin Rothe
  • Marc ReismannEmail author
Original Article



Phlegmonous and complicated appendicitis represent independent entities depending on hereditary immunological mechanisms. However, clinically there are no means to distinguish uncomplicated phlegmonous from complicated appendicitis. The ability to distinguish these two forms of appendicitis is relevant as current attempts are to treat both forms of the disease differently. The aim of the present study was to investigate differences in white blood cell counts (WBCs) in these conditions to identify areas of interest for future molecular studies.


White blood cell counts of patients aged between 7 and 14 years who underwent appendectomy from January 2008 to June 2016 were investigated with special reference to particular cellular subpopulations.


A total of 647 children were included in the study. Within distinct inflammatory patterns, significant eosinophilia and basophilia were found in phlegmonous inflammation compared with complicated inflammation (0.11 ± 0.19 × 109/L vs. 0.046 ± 0.104 × 109/L, P < 0.0001, and 0.033 ± 0.031 × 109/L vs. 0.028 ± 0.024 × 109/L, P < 0.001).


Compared with complicated disease, phlegmonous appendicitis seems to depend primarily on eosinophil inflammation. This observation is stable over time and indicates a direction for investigation of underlying genetic prerequisites.


Appendicitis Children Eosinophil granulocytes Immunology 


Author contributions

Study conception and design: MR, MIM, JR, KR. Acquisition of data: MR, MIM, DS. Analysis and interpretation of data: MR, MIM, JR. Drafting the manuscript: MR, MIM.



Compliance with ethical standards 

Ethical approval

Ethical approval for our study was obtained within the general regulations for retrospektive studies without relevance for diagnostics or treatment. General consent for the use of data for scientific evaluation had been obtained within hospital admission.

Conflict of interest

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. All authors declare that they have no conflict of interest.


  1. 1.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–25.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol. 2000;4:46–58.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ. 1994;308:107–10.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Svensson JF, Hall NJ, Eaton S, Pierro A, Wester T. A review of conservative treatment of acute appendicitis. Eur J Pediatr Surg. 2012;22:185–94.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Sasso RD, Hanna EA, Moore DL. Leukocytic and neutrophilic counts in acute appendicitis. Am J Surg. 1970;120:563–6.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Kumar V, Sharma A. Neutrophils: cinderella of innate immune system. Int Immunopharmacol. 2010;10:1325–34.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Romagnani S. Biology of human TH1 and TH2 cells. J Clin Immunol. 1995;15:121–9.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Thomas LL. Basophil and eosinophil interactions in health and disease. Chem Immunol. 1995;61:186–207.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Pecaric-Petkovic T, Didichenko SA, Kaempfer S, Spiegl N, Dahinden CA. Human basophils and eosinophils are the direct target leucocytes of the novel IL-1 family member IL-33. Blood. 2009;113:1526–34.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Rubér M, Berg A, Ekerfelt C, Olaisson G, Andersson RE. Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis. Clin Exp Immunol. 2006;143:117–24.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Rubér M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C. Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery. 2010;147:366–732.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36:39–51.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Fallon SC, Kim ME, Hallmark CA, Carpenter JL, Eldin KW, Lopez ME. Correlating surgical and pathological diagnoses in pediatric appendicitis. J Pediatr Surg. 2015;50:638–41.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.CrossRefGoogle Scholar
  16. 16.
    Fitz RH. Perforating inflammation of the vermiform appendix: with special reference to its early diagnosis and treatment. Am J Sci. 1886;92:321–46.Google Scholar
  17. 17.
    Svensson JF, Patkova B, Almström M, Naji H, Hall NJ, Eaton S, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg. 2015;261:67–71.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Son CS, Jang BK, Seo ST, Kim MS, Kim YN. A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis. BMC Med Inform Decis Mak. 2012;12:17.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Shrestha R, Shrestha A, Tiwari M, Ranabhat S, Maharjan S. Role of eosinophils in acute appendicitis. JNMA J Nepal Med Assoc. 2015;53:12–7.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018
corrected publication September 2018

Authors and Affiliations

  • Maximiliane I. Minderjahn
    • 1
  • Dag Schädlich
    • 1
  • Josephine Radtke
    • 1
  • Karin Rothe
    • 1
  • Marc Reismann
    • 1
    Email author
  1. 1.Department of Pediatric SurgeryCharité–Universitätsmedizin BerlinBerlinGermany

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