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Acute appendicitis in the under-5 year old

N Williams1, L Kapila

  • 1Department of Paediatric Surgery, University Hospital, Nottingham, UK.

Journal of the Royal College of Surgeons of Edinburgh
|June 1, 1994
PubMed

Insights

Acute appendicitis in children under five is rare but often overlooked. Early diagnosis is crucial, as a high perforation rate of 50% was observed in this age group, though mortality was zero.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Acute appendicitis is a common surgical emergency in children.
  • Appendicitis in children under five years old is infrequent and poses diagnostic challenges.

Purpose of the Study:

  • To analyze the clinical presentation, management, and outcomes of acute appendicitis in children under five years of age.
  • To identify factors contributing to delayed diagnosis and high perforation rates in this pediatric population.

Main Methods:

  • Retrospective analysis of 36 children under five diagnosed with acute appendicitis over a 10-year period.
  • Review of medical records to assess symptoms, diagnostic delays, surgical management, and postoperative complications.

Main Results:

  • Abdominal pain was present in 32/36 children; vomiting in 28/36.
  • Right iliac fossa tenderness was noted in 21/36, generalized tenderness in 10/36.
  • A 50% perforation rate was observed, inversely proportional to age; wound sepsis rate was 16.6%; no mortality.

Conclusions:

  • Acute appendicitis in very young children is often missed due to its low incidence and atypical presentations.
  • A high index of suspicion is essential for timely diagnosis and to mitigate the significant morbidity associated with delayed treatment in this age group.

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