Acute Appendicitis in Young Children: A Persistent Diagnostic Challenge for Clinicians

Abstract

Acute appendicitis is a grave and life-threatening condition in children, accounting for one to two cases per 10,000 in children less than four years' old. Prompt diagnosis and management are imperative to prevent serious complications, such as abscess formation, perforation, bowel obstruction, peritonitis, and sepsis. In young children, however, the diagnosis of this condition is challenging. The delayed utilization of imaging may further delay the diagnosis due to concerns of exposure to ionizing radiation. Even with a prompt diagnosis, controversy persists regarding medical versus operative management in these young patients.We report a case of a 21-month-old female who presented with fever, non-bilious, non-bloody emesis, and decreased tolerance for liquids and solids. The initial physical exam and imaging were suggestive of non-obstructive bowel distention. The patient was admitted to the pediatric floor. Overnight, the patient’s condition deteriorated severely and became septic. Repeat imaging revealed a 9-cm appendicular mass and a ruptured appendix. Antibiotic coverage was then broadened and the patient was transferred to the critical care unit for more intensive management. The patient’s septic condition improved over the upcoming few days and the parents elected to perform an elective appendectomy following resolution of the condition.Atypical presentations are common in this population. The difficulty in obtaining a reliable history and physical examination findings makes the diagnosis even more challenging. Moreover, concerns with radiation exposure may delay the diagnosis and increase the risk of perforation and peritonitis. Thus, clinicians should have a high index of suspicion for acute appendicitis, particularly in young children, as this condition is commonly missed on initial presentation.

Combining Ultrasound with a Pediatric Appendicitis Score to Distinguish Complicated from Uncomplicated Appendicitis in a Pediatric Population

“…However, no preoperative diagnostic method could completely confirm the results. Therefore, preoperative diagnosis of complicated appendicitis to have the right management is still a huge challenge ( 4 ).…”

Value of laboratory investigation data for the diagnostic of acute appendicitis in children

“…Своєчасна діагностика ГА залишається актуальною проблемою для дитячих хірургів цілого світу [15,20]. Затримка встановлення правильного діагнозу зумовлює зростання частоти перфорацій червоподібного відростка і, відповідно, збільшує ризик виникнення ускладнень, що призводить до зростання витрат на лікування [4,8].…”

Sepsis after non‐perforated acute appendicitis

“…Rapid diagnosis and treatment are necessary to prevent serious complications such as abscess, perforation, obstruction, sepsis, and peritonitis. Overlapping its symptoms with other childhood conditions, including gastroenteritis, increases the likelihood of errors and delays in diagnosis …”

“…Overlapping its symptoms with other childhood conditions, including gastroenteritis, increases the likelihood of errors and delays in diagnosis. 1 Appendicitis is a worm-like appendage whose base is located on the posterior side of the inner cecum. Although acute appendicitis is infrequent in infants (because its base is broad and has less chance of lumen obstruction) and children younger than 5 years, however a few rare neonatal and prenatal cases have been documented.…”