Appendicitis or non‐specific abdominal pain in pre‐school children: When to request abdominal ultrasound?

Abstract

Aim The aim of this study is to determine the most useful diagnostic tools to differentiate appendicitis from non‐specific abdominal pain (NSAP) in pre‐school children. Methods We prospectively evaluated all children aged 5 years or younger admitted for suspected appendicitis at a paediatric emergency department during 5 years. Cases of NSAP and appendicitis were enrolled according to inclusion and exclusion criteria. The different variables collected were assessed by statistic and diagnostic accuracy studies. Results A total of 82 patients were studied: 27 cases of NSAP and 55 cases of appendicitis. We found no symptoms or signs with a high power of discrimination between both processes. Complicated cases of appendicitis begin to appear when the duration of symptoms exceeds 12 h. Among laboratory tests, C‐reactive protein (CRP) value >34 mg/L was the variable with a greater association to appendicitis (odds ratio 9.8). Abdominal ultrasound (US) had high sensitivity and specificity to differentiate appendicitis, significantly improving its diagnostic accuracy when the duration of symptoms exceeds 12 h. Conclusions A good history and physical examination are important in the diagnostic process, but reliable physical signs can be difficult to elicit in pre‐school children. CRP and abdominal US are useful investigations that can improve diagnostic accuracy. According to our results, abdominal pain duration longer than 12 h or CRP value >34 mg/L should be an indication to perform an abdominal US in pre‐school children with right lower quadrant tenderness.

Resolution of Sonographic Appendicitis in Pediatrics: a Point of Care Ultrasound Case-Series

“…Early appendicitis without fecalith may be overcome by a healthy immune system, like other bacterial infections. Complicated appendicitis is unusual before 12 hours of abdominal pain 22 , and repeating sonography after a brief observation may eliminate the burden of cases that have resolved. Others demonstrate that pediatric perforated appendicitis occurs more commonly after the first 24 hours of symptoms 23 , 24 .…”

“…Early appendicitis without fecalith may be overcome by a healthy immune system, like other bacterial infections. Complicated appendicitis is unusual before 12 hours of abdominal pain [22], and repeating sonography after a brief observation may eliminate the Figure 6. Fluid filled 6.7-millimeter appendix in short-axis, surrounding mesenteric edema/ inflammation.…”

Non Surgical Causes of Acute Abdomen in Children: Surgeons Standpoint for Exclusion

“…Nonspecific abdominal pain is common among children. 22 Many proposed etiologies are labelled as the cause of acute abdomen in such cases. 22,23 In our study we found 12% (n=12) of cases as having nonspecific abdominal pain.7 % patients (n=7) presented with symptoms of UTI with severe abdominal pain.…”

“…22 Many proposed etiologies are labelled as the cause of acute abdomen in such cases. 22,23 In our study we found 12% (n=12) of cases as having nonspecific abdominal pain.7 % patients (n=7) presented with symptoms of UTI with severe abdominal pain. Abdominal pain may be a subjective feeling due to distress in these cases.…”