Authors
Rajendran R
Department of Pediatric surgery, Maternity & Children’s Hospital (under ministry of health), PB no.3600, Najran, Saudi Arabia
Abstract
Introduction: Acute appendicitis (AA) is the most common atraumatic acute surgical condition in children, with peak incidence between 11-12 years. Diagnosing AA in children presents significant challenges, particularly in younger age groups, leading to high misdiagnosis rates and associated morbidities.
Diagnostic Challenges: Misdiagnosis rates can reach 70-100% in children under 3 years due to non-specific symptoms and the rarity of the condition in infancy. In preschool-aged children, rates are 19-57%, often resulting in perforation. Misdiagnosed patients typically present with shorter symptom duration, late visits, fewer tests, and less imaging. AA can mimic various intra-abdominal pathologies, necessitating careful differential diagnosis. False-negative diagnoses lead to higher perforation rates, postoperative complications, and longer hospitalizations.
Diagnostic Tools: Clinical parameters like anorexia, migrating periumbilical pain, nausea, vomiting, fever, and specific tenderness points are crucial. Laboratory tests include total leukocyte and neutrophil counts, neutrophil-lymphocyte ratio, and CRP. Scoring systems like MANTRELS and Pediatric Appendicitis Score (PAS) aim to improve accuracy, though PAS has shown limitations. Imaging studies, primarily ultrasonography (US) and computed tomography (CT), are vital in equivocal cases. US is recommended as the initial imaging, with CT or MRI reserved for non-diagnostic US findings or when a prompt diagnosis is desired, balancing diagnostic accuracy with radiation exposure. Recent advances include biomarkers like calprotectin, IL-6, mean platelet volume, and procalcitonin.
Conclusion: Diagnosing AA in children requires a high index of suspicion and a comprehensive approach combining clinical evaluation, laboratory tests, and appropriate imaging to minimize misdiagnosis, prevent complications, and ensure timely surgical intervention.