From the Guidelines
Appendicitis in children typically presents with abdominal pain that migrates from the belly button to the lower right side of the abdomen, accompanied by nausea, vomiting, loss of appetite, and fever, and requires prompt medical attention to prevent complications. The diagnosis of appendicitis in children can be challenging, especially in younger children who may present with atypical symptoms 1. According to the 2020 update of the WSES Jerusalem guidelines, a tailored individualized diagnostic approach is recommended, taking into account the patient's age, sex, and clinical signs and symptoms 1.
Some key signs and symptoms of appendicitis in children include:
- Abdominal pain that worsens with movement, coughing, or jumping
- Nausea and vomiting
- Loss of appetite
- Low-grade fever (99-102°F)
- Diarrhea or constipation
- Irritability, difficulty walking, or curling up in a ball to relieve pain in younger children
- General fussiness, refusing to eat, and unusual lethargy in toddlers and infants
The pain migration pattern is a classic symptom of appendicitis, where the pain starts in the central abdomen and then shifts to the lower right side as the inflammation spreads to the surrounding tissues. If these symptoms are noticed, it is essential to seek immediate medical attention, as appendicitis is a medical emergency that requires prompt surgical intervention. Delaying treatment can lead to appendix rupture, which can cause more severe symptoms, including high fever and intense, widespread abdominal pain, and can result in serious complications like peritonitis 1.
In terms of diagnostic approach, the use of clinical scores, such as the Alvarado score and Pediatric Appendicitis Score, can be useful in excluding acute appendicitis in pediatric patients 1. Additionally, laboratory tests, including white blood cell count and CRP, can be helpful in predicting acute appendicitis in children 1. Imaging studies, such as ultrasound, may also be used to aid in diagnosis, especially in cases where the diagnosis remains uncertain after initial evaluation 1.
From the Research
Signs of Appendicitis in Children
The signs of appendicitis in children can be difficult to diagnose due to the variability of symptoms. However, some common signs include:
- Abdominal pain, particularly in the right lower quadrant 2
- Fever, which is the single most useful sign associated with appendicitis 2
- Rebound tenderness, which triples the odds of appendicitis 2
- Midabdominal pain migrating to the right lower quadrant, which increases the risk of appendicitis 2
- Elevated white blood cell count, although a count of less than 10,000/microL decreases the likelihood of appendicitis 2
Diagnostic Challenges
Diagnosing appendicitis in children can be challenging due to the similarity of symptoms with other conditions, such as:
- Crohn's disease 3, 4
- Inflammatory bowel disease 3
- Intestinal obstruction 4
- Carcinoid of the appendix 4
- Pseudoappendicitis, which can be caused by conditions such as ruptured hepatoblastoma 3
Importance of Clinical Evaluation
Clinical evaluation is crucial in determining which children with abdominal pain warrant immediate surgical evaluation for consideration of appendectomy and which children may warrant further diagnostic evaluation 2. A careful evaluation of abdominal pain and physical examination are essential in diagnosing appendicitis in children 4.