What causes pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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Acute appendicitis is a complex disease with quite a bit of variability in presentation and pathophysiology. Several theories have been promoted to explain the etiology, epidemiology and natural history of the disease. Many contend that appendicitis is due to obstruction of the blind ending appendix, resulting in a closed loop. In children, obstruction usually results from lymphoid hyperplasia of the submucosal follicles. The cause of this hyperplasia is controversial, but dehydration and viral infection have been proposed. Another common cause of obstruction of the appendix is a fecalith.

Rare causes include foreign bodies, parasitic infections (eg, nematodes), and inflammatory strictures.

The obstructive theory of appendicitis is widely taught but may not explain all the data regarding providers' experience with this common disease.  Outbreaks and clusters of appendicitis have been reported making a true infectious etiology a possible etiologic agent.  Appendicitis seems to run in families with first degree relatives of those who have had appendicitis being at a much higher risk of developing the condition which suggests an role of the host genetics. Finally, perforated and non-perforated appendicitis, which should be linked by the progression from early to late appendicitis, appear to act epidemiologically as two separate disease processes. Even though appendicitis is very common, much is not understood about the etiology or pathophysiology of this disease process.

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