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

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.