Appendicitis
This is the most common condition needing intra-abdominal surgery in childhood. Peak of age incidence in children is between six to twelve years old. This is more frequent in males than in females.
The primary etiology of the acute inflammation of the appendix is obstruction, which may be secondary to inflammatory changes either blood-borne or enteric infections, or mechanical as parasites, fecaliths or any other foreign body.
Clinically, the patient will usually present with a history of acute abdominal pain associated with nausea and vomiting. The abdominal pain will usually start around the umbilicus or in the epigastric area and after a few hours, the pain will localize at the right lower quadrant of the abdomen. However, in children this is very challenging since they are often vague and inaccurate in describing their complaints. Some will have right upper quadrant pain if the cecum is incompletely rotated and lies in a very high position. In cases where the inflammation involves the peritoneum, then the pain will become diffuse and severe.
Vomiting in acute appendicitis is an almost constant finding and is likely to be persistent. Fever is almost moderate to high grade. Bowel movements may be normal but constipation is common. Urinary tract symptoms are usually absent but dysuria can be brought about by an inflammed appendix which lies against the right ureter or the urinary bladder.
In infants and young children, the symptoms may not be classical. About 70% of children below 5 years of age or younger may present initially with signs and symptoms of perforation. They may appear acutely ill with rapid respiration, rigid abdomen, flaring of the alae nasi, and anxious expression. Prior to rupture of the appendix, temperature may be normal or low grade, but as peritonitis develops, the body temperature is usually elevated up to 41 degrees centigrade.
Acute appendicitis may be diagnosed by thorough history and physical examination. Laboratories are taken to help clinicians confirm their diagnosis.
Some medical conditions that may present like Appendicitis are mesenteric adenitis, urinary tract infections, pneumonia and Meckel’s diverticulitis. The treatment of Appendicitis is surgical. Antibiotic therapy is given in cases of ruptured appendicitis.