Hospital observation for right lower quadrant abdominal pain with questionable acute appendicitis in children

920 children below the age of 12 years were admitted with complaints of pain in the right lower abdomen and a suspected diagnosis of acute appendicitis. In 720 patients, clinical diagnosis was made and immediate operation was performed. In 644 of them (89.5%) an intraabdominal lesion was found but in 76 (10.5%) no disease was encountered. Rest 200 patients were observed in the ward and progression was noted at regular intervals. Eight of these patients did not improve while on observation and they were operated. Five others did not have acute appendicitis but in them definite medical diagnosis was made. However in remaining 187 observed patients abdominal signs gradually resolved and needed no surgery but no definite diagnosis also could be made. They appeared to have non-specific abdominal pain. The conclusion of the study was that inhospital observation of patients with right lower quadrant abdominal pain and questionable appendicitis upto three days was a safe way to reduce the rate of negative appendicectomies and unnecessary surgical exploration.