Appendicitis

Inflammation of the appendix; main differential for an acute abdomen presentation in a child

Clinical presentation

Symptoms

  • The key presenting feature of appendicitis is abdominal pain - typically starts as central abdominal pain, that moves down to the right iliac fossa over time and eventually becomes localised in the RIF
  • Other classic features are:
    • Anorexia
    • Nausea and vomiting
    • Moderate temperature

Signs

  • Tenderness in McBurney’s point
  • Rosving’s sign - palpation of the left iliac fossa causes pain in the RIF
  • Guarding on abdominal palpation
  • Rebound tenderness - increased pain when quickly releasing pressure on the right iliac fossa
  • Percussion tenderness - pain and tenderness when percussing the abdomen
  • Painful movements (can't jump, feels every bump on the way to hospital) suggests peritonitis

Investigations

  • Usually clinical diagnosis based on presentation and raised inflammatory markers
  • US abdomen may find the inflamed appendix - good test in children if diagnosis uncertain

Management

  • Appendicectomy