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Diagnostic challenges of acute appendicitis in preschool children: A comprehensive case-control study
Maya Paran1,2, Yael Dreznik1,2, Moussa Totah1,2
1Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel.
Insights
Diagnosing acute appendicitis in preschool children is challenging due to atypical symptoms like vomiting and fever. These younger patients experience more complicated appendicitis and surgical issues compared to school-aged children.
Area of Science:
- Pediatric Surgery
- Pediatric Gastroenterology
- Emergency Medicine
Background:
- Acute appendicitis is a frequent surgical emergency in children.
- Preschool-aged children often present with atypical symptoms, complicating diagnosis.
Purpose of the Study:
- To compare the clinical characteristics of acute appendicitis in preschool children versus school-aged children.
- To identify distinct diagnostic challenges and outcomes in younger pediatric appendicitis patients.
Main Methods:
- A retrospective case-control study included children under 5 years (preschool) and 5-10 years (school-aged) diagnosed with acute appendicitis.
- Data collected included demographics, clinical presentation, laboratory results, imaging, surgical details, pathology, and outcomes.
Main Results:
- Preschoolers showed less abdominal pain but more vomiting, diarrhea, and fever.
- Younger children had lower leucocytosis but higher thrombocytosis and C-reactive protein.
- Complicated appendicitis, increased drain use, open conversions, ICU admissions, and surgical complications were more frequent in preschoolers.
Conclusions:
- Healthcare providers need heightened awareness of atypical appendicitis presentations in preschool children.
- Recognizing these patterns is crucial for improving diagnostic accuracy and timely management in this vulnerable age group.
Aim:
Acute appendicitis is a common surgical emergency in children, yet it poses diagnostic challenges in preschool children due to atypical presentation. This case-control study aims to evaluate the distinct characteristics of acute appendicitis in preschool compared to school-aged children.
Methods:
Children under 5 years and a control group of children aged 5-10 years, operated on due to acute appendicitis at our institution during 2009-2022 were included. Data on demographics, clinical presentation, laboratory results, imaging, surgical procedure, pathology, bacteriology, antibiotic treatment, length of stay and outcomes were collected retrospectively.
Results:
A total of 184 preschool and 187 school-aged children were included. Preschool children presented less frequently with abdominal pain but more often with vomiting, diarrhoea and fever. Preschool children had lower rates of leucocytosis but higher thrombocytosis and C reactive protein. Younger patients were more likely to undergo both chest and abdominal X-rays and be admitted to a paediatric department before diagnosing appendicitis. Complicated appendicitis, requiring increased use of intra-operative drain placement, and conversions to open procedures were more common in preschool children, with higher rates of ICU admission and surgical complications. Polymicrobial positive cultures and positive cultures for Bacteroides were more common in preschool children.
Conclusions:
This study highlights the critical need for increased awareness among healthcare providers regarding the diagnostic challenges posed by atypical presentations of acute appendicitis in preschool children. Despite comprehensive evaluation, diagnosis in this age group may be difficult, emphasising the significance of recognising these presentation patterns to improve diagnostic accuracy and prompt management.
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