Diarrhea as a Diagnostic Challenge in Pediatric Appendicitis: A Clinical Cohort and Nationwide Survey of 1,114...

Diarrhea may complicate the recognition of pediatric appendicitis because it commonly suggests acute gastroenteritis. We evaluated this diagnostic challenge using a clinical cohort and a nationwide questionnaire survey.

We retrospectively compared children aged <16 years with acute appendicitis with and without diarrhea at a single tertiary care center. Separately, we conducted a nationwide questionnaire survey of physicians providing outpatient pediatric care in Japan. Distinct items assessed the initial diagnostic impression and intended management in a hypothetical case.

Among 122 children with appendicitis, 21 (17.2%) had diarrhea. C-reactive protein levels were higher in the diarrhea group than in the non-diarrhea group (3.80 vs. 1.65 mg/dL; p=0.006). The perforation rate was numerically higher in children with diarrhea (7/21 (33.3%) vs. 14/101 (13.9%)) but did not reach statistical significance (p=0.067). Among 1,114 physicians who participated in the nationwide survey, 1,035 of 1,110 respondents to the diagnostic item (93.2%) selected acute gastroenteritis as the most likely initial diagnosis. In a separate hypothetical management case, 994 of 1,104 respondents (90%) selected immediate referral.

Diarrhea was not uncommon among children with appendicitis and was associated with higher C-reactive protein levels in this cohort. An initial impression of gastroenteritis was common, while immediate referral was also frequently selected. Persistent or progressive abdominal symptoms should prompt reassessment for appendicitis even when diarrhea is present.