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Appendicitis in children less than five years old: A challenge for the general practitioner

Pierluigi Marzuillo1, Claudio Germani1, Baruch S Krauss1

  • 1Pierluigi Marzuillo, Department of Women and Children and General and Specialized Surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.

World Journal of Clinical Pediatrics
|May 28, 2015
PubMed

Insights

Acute appendicitis is uncommon in young children but can be misdiagnosed as gastroenteritis. Early diagnosis of appendicitis in pediatric patients is crucial to prevent complications like perforation.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Emergency Medicine

Background:

  • Acute appendicitis is a frequent surgical indication in children, peaking in adolescence.
  • Appendicitis in early childhood, especially infancy, is rare and challenging to diagnose.
  • Gastroenteritis is a common misdiagnosis, with diarrhea occurring in 33-41% of pediatric appendicitis cases.

Purpose of the Study:

  • To review the epidemiology, pathophysiology, and clinical presentation of appendicitis in young children.
  • To identify key clinical signs and laboratory clues for early diagnosis.
  • To propose an algorithm for the timely diagnosis of appendicitis in pediatric patients.

Main Methods:

  • Literature review focusing on appendicitis in children under five years old.
  • Analysis of clinical presentation, diagnostic challenges, and misdiagnosis patterns.
  • Synthesis of epidemiological data and diagnostic indicators.

Main Results:

  • Pain is the primary symptom in children under five, followed by vomiting and fever.
  • Focal tenderness is the most common physical finding (61%), followed by guarding (55%).
  • Perforation risk increases with younger age, with 70% of patients under three perforating within 48 hours.

Conclusions:

  • Appendicitis diagnosis in young children is complex due to varied symptoms and frequent misdiagnosis.
  • Early recognition of clinical signs like focal tenderness is vital.
  • A structured diagnostic approach can reduce perforation rates and improve outcomes in pediatric appendicitis.

Keywords:
AppendicitisAppendicitis complicationsChildrenEarly diagnosisNewborn

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