• Acute Appendicitis in

Children
 pathogenesis
• It had been postulated that acute
appendicitis is initiated by a luminal
obstruction due to lymphoid
hyperplasia, faecolith
• ingested foreign bodies or parasite.
• Bacterial infiltration Mixed bacterial
growth of aerobic and anaerobic
organisms mainly Yersinia, Salmonella,
,Shigellam….
 Clinical presentation
• Acute appendicitis represents the
most common surgical cause of acute
abdominal pain among children.
• It accounts for one third of
abdominal pain admissions to the
surgical ward.
• Boys are affected more than girls
with a life time risk of 8.67% vs 6.7%
 Clinical presentation
• clinical skills and time with active
observation.( Symptoms)
• Anorexia
• abdominal pain(periumbilical region
vague)-shifts to the right iliac fossa
somatic pain develops when the
inflamed appendix attaches the
parietal peritoneum.
 Clinical presentation
• nausea and vomiting
• Diarrhea unusual
• Fever
(Signs)
• The child may be examined more than
once to reach the diagnosis especially
in infants and toddlers
• Tenderness in the right iliac fossa
can be elicited by palpation or
percussion over the McBurney point
Rebound tenderness
Cough Sign
Rovsing Sign
Psoas Sign
Obturator Sign
• Digital rectal examination
• bowel sounds have little value in children with a
noncomplicated acute appendicitis
 Testes
 Lab
• Leukocytosis
• Neutrophilia
• CRP
Radiology especially in preschool

• Ultrasound(sensitivity and specificity

more than 90%.(diameter,mass,collection)
• Ct scan sensitivity and specificity
(>95%)(
 Treatment
simple
• Open Appendectomy
• Laparoscopic Appendectomy
Complicated
• Abscess Drainage + Appendectomy
• Mass (conservative treat +interval
appendectomy
Key points
1. Appendicitis is rare in child < 5 years
2. Adolescence is the common age group
3. Diagnosis is usually made based on a
clinical
4. imaging usually is helpful in assessing
complicated appendicitis.
5.The outcome is the same for open and
laparoscopic