Overview
Appendicitis describes acute inflammation of the appendix and is a surgical emergency and a very common cause of abdominal pain in children. Its diagnosis is difficult as it does not always present with the classical history of central abdominal pain that localises to the right iliac fossa, fever, and anorexia.
Epidemiology
- Appendicitis is the most common cause of an acute abdomen in the UK
- Appendicitis is most common between 10-20 years but can happen at any age
- Appendicitis is uncommon under 3 years of age
Presentation
Overview
Infants and children may present with non-specific acute abdominal pain, and anorexia, and may appear withdrawn. Features include:
- Acute abdominal pain – may be epigastric and migrates to the right lower quadrant
- Worsened by movement
- Sudden relief may suggest appendiceal perforation
- Fever
- Nausea
- Vomiting
- Anorexia
- Dysuria
- Diarrhoea
Investigations
Referral
An emergency admission to hospital should be arranged if a child or young person is suspected to have appendicitis. Investigations may include:
- Full blood count (FBC):
- May show neutrophil-predominant leukocytosis
- C-reactive protein (CRP):
- May be elevated
- Urine dipstick test:
- May show leukocytes
- Ultrasound scan:
- Diagnostic
Differential Diagnoses
Mesenteric adenitis
- There is usually a history of a recent upper respiratory tract infection
- Generalised lymphadenopathy may be present
- Mesenteric adenitis and appendicitis may present similarly
- It may be difficult to distinguish the two
- In mesenteric adenitis, lymphocytosis is more likely than neutrophilia
Meckel’s diverticulum
- Most patients are asymptomatic and a few present with inflamed diverticula that can mimic appendicitis
- It may be difficult to distinguish the two
Intussusception
- Usually seen in younger children (<3 years old)
- Infants have episodes of colicky pain with pain-free periods
- During episodes of pain, the infant may draw their knees up and turn pale
- There may be a sausage-shaped abdominal mass
- There may be bloodstained stool similar to ‘red-currant jelly’ – a late sign
Viral gastroenteritis
- Appendicitis can cause diarrhoea and the two may present the same
- Other household members may be ill
- It may be difficult to differentiate between the two
Urinary tract infection
- Dysuria or crying when passing urine
- Tenderness in the suprapubic area
- Urine dipstick may show nitrites
- It may be difficult to differentiate between the two
Management
Overview
- Prophylactic IV antibiotics and appendicectomy:
- This is generally done by an open or laparoscopic approach
