Which clinical history findings are characteristic of pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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The classic history of anorexia and vague periumbilical pain, followed by migration of pain to the right lower quadrant (RLQ) and onset of fever and vomiting, is observed in fewer than 60% of patients. [2] If the appendix perforates, an interval of pain relief is followed by development of generalized abdominal pain and peritonitis. Although some patients progress in the classical fashion, some patients deviate from the classic model. Atypical presentations are common in neurologically impaired and immunocompromised patients, as well as in children who are already on antibiotics for another illness.

In patients with a retrocecal appendix, who constitute 15% of cases, signs and symptoms may not localize to the RLQ but instead to the psoas muscle, the flank or right upper quadrant. In other patients, the tip of the appendix is deep in the pelvis, and the signs and symptoms localize to the rectum or bladder resulting in pain with defecation or voiding.

Certain features of a child's presentation may suggest a perforated appendix. A child younger than 6 years with symptoms for more than 48 hours is much more likely to have a perforated appendix. The child may have generalized abdominal pain and may have a high heart rate and a temperature higher than 38°C.

A substantial risk of perforation within 24 hours of onset was noted (7.7%) in one study and was found to increase with duration of symptoms. While perforation was directly related to the duration of symptoms before surgery, the risk was associated more with prehospital delay than with in-hospital delay. [1]

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