Appendicitis (General Pediatric Surgery of Abdomen)

Abstract

Appendicitis is a surgical emergency, characterized classically by right lower quadrant pain, vomiting, and fever, due to an inflamed vermiform appendix. The lifetime risk of developing acute appendicitis is approximately 9%, with children aged 10–14 years being most commonly affected. The exact etiology of this condition is incompletely understood. Appendicitis may be complicated by perforation or formation of an intra-abdominal abscess or inflammatory mass. Diagnosis is primarily dependent on clinical parameters with radiological investigations such as ultrasound and computed tomography being of value in those with inconclusive clinical findings. A high index of suspicion is required in preschool children who commonly present with atypical features and more advanced appendicitis. Laboratory investigations lack sensitivity or specificity for diagnosis. Following diagnosis, expedient surgery following fluid resuscitation and broad-spectrum antibiotic therapy is appropriate in most cases. In those with an appendix mass, initial non-operative treatment with antibiotics followed by interval appendectomy may be the best approach. Laparoscopic appendectomy has several advantages over open appendectomy regarding postoperative pain control, ileus, return to diet, and duration of hospital stay. It is thus becoming a more frequently used operative modality for appendicitis. Surgical site infections and intestinal obstruction are the most commonly encountered complications. Postoperative antibiotics reduce the incidence of surgical site infection, especially in complicated appendicitis. While the principles of diagnosis and treatment of appendicitis have changed little in the last century, developments in laparoscopic technology, like single-port appendectomy, and changing evidence regarding non-operative treatment of uncomplicated appendicitis may improve patient outcomes in the future.