From the Guidelines
Appendicitis in pediatric patients typically presents with abdominal pain that often begins around the umbilicus and migrates to the right lower quadrant of the abdomen, accompanied by nausea, vomiting, decreased appetite, and fever, although atypical symptoms are common in younger children. The clinical presentation of appendicitis in children can vary widely, making diagnosis challenging 1. According to the American College of Radiology, acute appendicitis is the most common abdominal surgical urgency/emergency in children, with approximately 70,000 cases per year in the United States 1. The incidence of appendicitis peaks during adolescence and is uncommon in infants and preschool children, and rare in newborns 1.
Key symptoms of appendicitis in children include:
- Abdominal pain that worsens over 24-48 hours
- Nausea and vomiting
- Decreased appetite
- Fever
- Guarding or rebound tenderness on abdominal examination However, younger children may exhibit atypical symptoms, such as:
- Irritability
- Lethargy
- Refusal to move
- Diarrhea, which can lead to misdiagnosis as gastroenteritis 1.
The diagnosis of appendicitis is often delayed in children, particularly in those under 5 years of age, due to the lack of classic symptoms and the difficulty in communicating their symptoms 1. Prompt medical evaluation is essential when appendicitis is suspected, as early diagnosis and surgical intervention significantly reduce complications. Imaging plays a crucial role in the diagnosis of pediatric acute appendicitis, and the choice of imaging modality depends on the clinical risk and scenario 1.
From the Research
Clinical Presentations of Appendicitis in Pediatric Patients
The clinical presentations of appendicitis in pediatric patients can vary depending on the age group.
- In children younger than 3 years of age, the symptoms and signs of appendicitis are usually nonspecific, with a higher incidence of fever, abdominal distention, and perforation 2.
- Children in this age group also tend to have a longer duration of symptoms before diagnosis and a higher complication rate compared to older children 2.
- In preschool children, atypical presentations of appendicitis are common, making diagnosis more challenging 3.
- Classic features of appendicitis, such as periumbilical pain migrating to the right iliac fossa, anorexia, fever, and tenderness in the right iliac fossa, are less common in younger children 3.
- In infants, appendicitis can present with non-specific symptoms such as grunting, pallor, fussiness, emesis, and diarrhea, making diagnosis difficult 4.
- Laboratory tests and imaging studies, such as ultrasound and computed tomography (CT) scans, can be useful in diagnosing appendicitis in children, especially when clinical symptoms are not typical 5, 6.
- The predictive utility of composite measures based on multiple sources of diagnostic information and clinical pathways can also aid in the diagnosis of appendicitis in pediatric patients 5.