Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study

The purpose of this study was to examine the presenting symptoms, signs perforation rates and outcomes of appendicitis in pre-school children. In addition, we sought to determine the reasons of delay in the diagnosis of those with complicated appendicitis.

This is a retrospective study of all children of 5 years or less who underwent appendectomy for appendicitis in King Khalid University Hospital, Riyadh, Saudi Arabia between January 2001 and December 2007.

During the 7-year period, 106 patients 5 years of age or less required appendectomy for appendicitis. There were 66 boys and 40 girls. Sixty-four children (60.3%) had complicated appendicitis, 38 (35.3%) had acute appendicitis and 4 (3.7%) had normal appendix. Although classic symptoms were present in the majority of patients, atypical symptoms were found in some children. The duration of symptoms in patients with complicated appendicitis was more (5.2 vs 2.1 days). A diagnosis other than appendicitis was suspected in 47 patients (73.4%). Sixty (56.6%) patients had perforation at the time of surgery. Complicated appendicitis was associated with a longer hospital stay and more post-operative complications.

The accurate diagnosis of appendicitis in pre-school children is still a clinical challenge. A high index of suspicion of appendicitis is necessary in pre-school children in view of the atypical presentation and high incidence of complicated appendicitis. Primary care physician, emergency room physician and young surgeons have a crucial role in recognizing the symptoms and signs of early appendicitis in pre-school children.