Acute appendicitis

Abstract Acute appendicitis, the most common reason for abdominal surgery in children, occurs when the appendix becomes inflamed. Luminal obstruction of the appendix may progress to suppurative inflammation and perforation, and in some children, this progresses further to cause generalized peritonitis or an appendix mass/abscess. Typically, the child complains of periumbilical pain that is perceived to shift to the right iliac fossa and is associated with anorexia and fever. Key clinical features are tenderness and guarding in the right iliac fossa. Atypical presentations are common, particularly in preschool children, and these may contribute to delays in diagnosis and treatment. A clinical diagnosis is possible in most cases, if necessary after a period of active observation; inflammatory markers and ultrasonography are useful supportive investigations in selected cases. Treatment is by appendicectomy after appropriate fluid resuscitation, analgesia, and intravenous antibiotics. Laparoscopic appendicectomy is associated with reduced analgesic requirements and a shorter hospital stay, but has similar complication rates to open appendicectomy. Routine peritoneal fluid cultures are unnecessary, but histology of the appendix is advisable. Management of the appendix mass and pelvic abscess remains controversial and is being influenced by advances in imaging and interventional drainage techniques. Similarly, the indications for treatment by antibiotics alone are still being established.