Appendicitis on Pediatric Patients: Current Evidence in Diagnosis and Treatment

Abstract

Appendicitis is a common surgical condition in pediatric patients, with a higher prevalence among males by 55 – 60%. The etiology is not definitively established, but luminal obstruction caused by stool, lymphoid hyperplasia, or parasites is a commonly cited cause. The classic presentation includes the gradual onset of periumbilical abdominal pain with migration to the right lower quadrant within 24 hours, fever, anorexia, nausea, and vomiting. However, infants and young children may present differently. Risk scores have been developed to improve the accuracy of diagnosis by using clinical symptoms, physical examination, and laboratory results. Ultrasound is the recommended imaging modality due to its low cost and avoidance of radiation, with reported sensitivity ranging from 72.5% to 94.8% and specificity of 95% to 99%, depending on the operator's experience. In young preschool-age children, acute appendicitis carries a higher risk of complications, including surgical site infections and abscesses. The risk of appendix perforation increases with delayed diagnosis. Treatment involves fluid resuscitation, pain control, antibiotics, and appendectomy. In cases of perforation, percutaneous drainage may be necessary. Hospital readmissions are often due to infection, bowel obstruction, or abdominal pain.