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Pitfalls in paediatric appendicitis: Highlighting common clinical features of missed cases

Melanie D W Seah1, Kee-Chong Ng

  • 1Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore. melanie_SEAH@ttsh.com.sg

Asian Journal of Surgery
|November 14, 2006
PubMed

Insights

Pediatric appendicitis is often missed, with common symptoms like nausea, vomiting, and fever. Misdiagnoses of gastroenteritis or constipation delay critical treatment, increasing surgical complications.

Area of Science:

  • Pediatric Surgery
  • Emergency Medicine
  • Diagnostic Accuracy

Background:

  • Delayed diagnosis of pediatric appendicitis leads to increased surgical complications.
  • Identifying clinical features of missed appendicitis cases is crucial for timely intervention.

Purpose of the Study:

  • To identify common clinical features of pediatric appendicitis cases that were initially missed at first hospital attendance.
  • To understand the diagnostic challenges and outcomes associated with delayed appendicitis diagnosis in children.

Main Methods:

  • Retrospective review of case records for pediatric patients with missed appendicitis diagnoses.
  • Documentation of patient presentation, investigations, initial diagnoses, and outcomes.

Main Results:

  • 7% of appendicitis cases were missed over a 2-year, 5-month period, involving 39 patients.
  • Common symptoms included nausea, vomiting, and fever; abdominal pain was rarely localized to the right iliac fossa (5.1%).
  • Gastroenteritis (51.3%) and constipation (25.6%) were the most frequent initial misdiagnoses, leading to delayed surgery in 51.3% of discharged patients.

Conclusions:

  • The absence of right lower quadrant pain does not rule out appendicitis in children.
  • Gastroenteritis and constipation are significant mimics of pediatric appendicitis, necessitating a high index of suspicion.
  • Avoiding wrongful discharge is critical to prevent delayed surgical intervention and associated complications.
Abstract

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