There is a need to consider acute appendicitis in acute abdomen in children: A case report.
Fente B1, Egu CB2*
1Department of Surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria.
2Department of Surgery, Gloryland Medical Centre, Yenagoa, Bayelsa State, Nigeria.
*Correspondence: Dr. Egu, Chinedu Brian; +2348062879477; firstname.lastname@example.org
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Background: Appendicitis is relatively rare in infants under 36 months of age and for obvious reasons the patient is unable to give a history. The diagnosis is therefore delayed with increase in the incidence of complications which may occur such as bowel perforation. Appendicitis in this young age group is also more aggressive, possibly because of their short omentum. Complete aversions to food, vomiting, lack of sleep during the attack and complete absence of bowel sounds at the early stages are very common features.
The diagnosis of acute appendicitis in children remains a challenge, even with the availability of advanced diagnostic imaging. Many patients present late with complications. Here, we report a case of perforated gangrenous appendix presenting as intestinal obstruction in a 4-year-old.
Case presentation: A 4-year-old female presented to our Emergency Department with generalized abdominal pain and distension that we explored for presumed intussusception. On exploration, laparotomy revealed purulent fluid localized in the right lower quadrant of the abdomen, gangrenous appendix with perforation at its base, gross bowel oedema at the ileocecal junction, side-to-side adhesion of a loop of the small bowel close to the ileocecal junction.
Conclusion: Acute appendicitis in young children is uncommon. The delay encountered in the diagnosis and management may be as a result of poor communication skill, inability to elicit physical signs in children that are irritable, atypical presentation, and overlap of symptoms with other disorders. When patients present late to the hospital, complications such as perforated appendix and peritonitis may ensue. To make a diagnosis in this age group, requires a high index of suspicion, a careful history, and thorough physical examinations. Early diagnosis and prompt surgical intervention helps to reduce the high-risk of morbidity and mortality that is associated with complicated appendicitis.
Key words: Appendicitis, Intestinal obstruction, Pre-school children, Acute abdomen.
Cite this article: Fente B, Egu CB. There is a need to consider acute appendicitis in acute abdomen in children: A case report. Yen Med J. 2020;2(2):96–99.
- O’ Connell PR, Russell RC, Williams NS, Bulstrode CJ. The vermiform appendix. In: Russell RC, Williams NS, Bulstrode CJ, eds. Bailey and Love’s Short Practice of Surgery, 23rd ed. London, UK: Arnold; 2000:1076–1083.
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–925.
- Albiston E. The role of radiological imaging in the diagnosis of acute appendicitis. Can J Gastroenterol. 2002;16(7):451–463.
- Bachoo P, Mahomed AA, Ninan GK, Youngson GG. Acute appendicitis: the continuing role for active observation. Pediatr Surg Int. 2001;17(2-3):125–128.
- Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39–51.
- Fente BG, Echem RC. Prospective evaluation of the Bengezi and Al-Fallouji modified Alvarado score for presumptive accurate diagnosis of acute appendicitis in University of Port Harcourt Teaching Hospital, Port Harcourt. Niger J Med. 2009;18(4):398-401.
- Puri P, Boyd E, Guiney EJ, O’Donnell B. Appendix mass in the very young child. J Pediatr Surg. 1981;16(1):55–57.
- Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care. 2000;16(3):160–162.
- Almaramhy H.H. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr.2017;43(1):15.
- Chang YJ, Chao HC, Kong MS, Hsia SH, Yan DC. Misdiagnosed acute appendicitis in children in the emergency department. Chang Gung Med J. 2010;33(5):551–7.
- Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557–564.
- Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med. 2007;49(6):778–784.
- Minneci PC, Mahida JB, Lodwick DL, Sulkowski JP, Nacion KM, Cooper JN, et al. Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg. 2016;151(5):408–415