Acute appendicitis in children

This may occur at any age, being more common in children of school age and in adolescence, and uncommon under 3 years of age. Special problems of early diagnosis occur with the very young (less than 3 years) and in mentally retarded children, many of whom present with peritonitis. Vomiting occurs in at least 80% of children with appendicitis and diarrhoea in about 20%. The temperature is usually only slightly elevated but in about 5% of cases it exceeds 39°C. 1 In children the physical examination, especially eliciting abdominal (including rebound) tenderness, and the rectal examination demand considerable tact, patience and gentleness. Jumping or hopping induces pain.

A serious point of confusion can occur between pelvic appendicitis, causing diarrhoea and vomiting, and acute gastroenteritis. A particularly severe case of apparent gastroenteritis, especially if persistent, should be regarded as pelvic appendicitis until proved otherwise.

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