Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

🧾 Introduction

• Appendicitis is relatively uncommon in children under 5 years old, but carries a ⚠️ very high risk of perforation (up to 90%), making early recognition vital.
• Differentials include 🤒 viral gastroenteritis, 🚽 UTI, or 🧩 mesenteric adenitis, as presentations are often atypical in this age group.

🧍 Clinical Presentation

• History:
  • 📍 Pain → typically localises to the right lower quadrant (RLQ), though in young children it may be vague or diffuse.
  • ⏳ Usually no prior history of recurrent abdominal pain (distinguishes from functional pain).
  • 🍽️ Anorexia and 🤢 vomiting are common but non-specific.
  • 🚫 No cough / no urinary symptoms → helps exclude chest or urinary causes.
• Examination:
  • 🌡️ Fever and ❤️ tachycardia suggest infection.
  • 🚶 If the child can hop or sit forward comfortably → appendicitis less likely.
  • 👩‍⚕️ Abdominal tenderness (esp. RLQ) ± guarding → key clinical sign.

🧪 Diagnosis and Tests

• 🧩 Low sensitivity & specificity → imaging & labs often unreliable in <5s.
• 🖼️ Ultrasound / CT may be inconclusive due to small size or poor visualisation.
• 🧾 Bloods: WCC / CRP may be raised but are not diagnostic.
• 🧑‍⚕️ Clinical judgment remains most important in diagnosis.

🩺 Management

• 👨‍⚕️ Early referral to a paediatric surgeon is essential if suspected.
• 🚑 Children with severe pain or prolonged history → high risk of perforation → need urgent surgery.
• 🔪 Appendectomy: usually laparoscopic if non-perforated.
• 💊 If perforated → surgical drainage + IV antibiotics (e.g., broad-spectrum with anaerobic cover).

✅ Conclusion

• 🧒 Appendicitis in children under 5 is rare but dangerous due to the ⚠️ very high perforation rate.
• 🧑‍⚕️ Diagnosis depends on history + examination + clinical judgment, as tests are often inconclusive.
• 🚑 Early surgical review and ⏱️ timely appendectomy are key to preventing peritonitis or sepsis.