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Appendicitis in the young child: a continuing diagnostic challenge.

M L Nance¹, W T Adamson, H L Hedrick

¹Department of Pediatric Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104, USA. nance@email.chop.edu

Pediatric Emergency Care

|July 11, 2000

Summary

Appendiceal perforation is common in young children, increasing with younger age and longer symptom duration. Perforation leads to longer hospital stays and abscess formation, but no deaths were reported in this study.

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Area of Science:

Pediatric Surgery
Gastroenterology
Clinical Pediatrics

Background:

Appendicitis in children under 5 presents unique diagnostic challenges.
Perforation is a significant complication in pediatric appendicitis.
Early diagnosis and treatment are crucial for favorable outcomes.

Purpose of the Study:

To analyze the signs and symptoms of appendicitis in children aged 5 years or less.
To determine the perforation rate in this age group.
To assess the impact of perforation on patient outcomes.

Main Methods:

Retrospective review of medical records for children aged 5 or less undergoing appendectomy.
Data collected included demographics, symptoms, physical signs, and diagnostic findings.

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Perforation and abscess presence determined by intraoperative findings.

Main Results:

74% of appendicitis cases in children 5 or less involved perforation.
Perforation rates increased significantly in younger children and with longer symptom duration (4.7 vs 2.1 days).
Perforation was associated with longer hospital stays (9 vs 3 days) and abscess formation (47% vs 0%).

Conclusions:

Appendiceal perforation is frequent in young children, particularly the youngest.
Decreasing age and prolonged symptoms are risk factors for perforation.
Perforation significantly increases hospital stay duration and the likelihood of abscess formation.