DIAGNOSIS AND TREATMENT: APPENDICITIS IN CHILDHOOD

Abstract

AS RECENTLY AS 1958, 258 children died in this country as a result of appendicitis. Most of these deaths occurred in young children with perforation. Correct early diagnosis of acute appendicitis and precise and vigorous management of children with advanced appendicitis can prevent these deaths. Particular attention should be paid to the pre-school child with abdominal pain. The historical and physical findings which are generally called classical are more common in older children. The intraluminal pressure of the obstructed appendix of the young child is built up to the same order as in the adult, but the intravascular pressure is lower and the bowel wall thinner. This results in the rapid development of necrosis. These two factors—difficulty in diagnosis and a fulminating course—lead to a high incidence of perforation in children. Combining the statistics of four large series of 551 children, age 4 years and under, with appendicitis, 429 or 77% were found to have perforated appendixes. This high incidence of perforation has not decreased over the years. THE EARLY DIAGNOSIS OF APPENDICITIS Abdominal pain is the prime symptom of appendicitis. Its character and location depend on the anatomic position of the inflamed appendix and the stage of development of the disease process. The young child is often not able to verbalize his complaint of abdominal pain or localize accurately the area of his abdominal discomfiture. Fretfulness, crying, disturbed sleep, and resistance to handling are often the first indications that something is wrong. Anorexia and vomiting are common accompaniments of many childhood illnesses. However, the presence of a good appetite casts some doubt on the diagnosis of appendicitis.