Which rectal exam 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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Answer

The digital rectal examination is often deferred but can be helpful in establishing the correct diagnosis, especially in sexually active adolescent girls. The patient should be told that the examination is uncomfortable but should not cause sharp pain. The caliber of the patient's anus should be taken into consideration, and smaller digits should be used for examining younger patients.

The rectal examination is particularly important in the child with a pelvic appendix, in whom the findings on the abdominal examination for appendicitis may be equivocal and indicative of peritoneal irritation.

Objective information to ascertain includes impacted stool or an inflammatory mass. Right-sided tenderness of the rectum is the classic finding in patients with pelvic appendicitis or in those with pus that pools in the pelvis from an inflamed appendix elsewhere in the abdomen.

Patients who are able to communicate should be asked if they have tenderness in different areas of the rectum. The rectal examination in a young child may have to be completely objective because they may not be able to communicate variations in tenderness or may have general discomfort from the examination.


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