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Does elevated urinary 5-hydroxyindole acetic acid level predict acute appendicitis in children?
  1. Ana Bosak Versic,
  2. Nedeljka Glavan,
  3. Nado Bukvic,
  4. Zlatko Tomasic,
  5. Harry Nikolic
  1. Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia
  1. Correspondence to Dr Ana Bosak Versic, Pediatric Surgery Clinic, University Hospital Center Rijeka, Istarska 43, Rijeka 51000, Croatia; anabosak{at}


Background Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis.

Objective We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis.

Methods We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography.

Results Acute appendicitis was diagnosed in 81 patients, whereas there were other explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group. The control group comprised 102 healthy children. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively.

Conclusions Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children.

  • abdomen
  • diagnosis
  • paediatric emergency med

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  • Contributors ABV and HN designed the study. All of the authors took part in collecting the samples from the participants and performing the surgeries, depending on the work schedule. ABV performed the sample analysis. ABV, NG and HN wrote the first draft of the paper. ABV, NG, NB, ZT and HN contributed to the revision of the paper and approved the final version.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Ethics committee of University Hospital Centre Rijeka, Croatia and Medical School of Rijeka, Croatia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data or analyses can be obtained from the corresponding author upon request.

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