Acute Appendicitis

Acute appendicitis is the most common cause for emergency abdominal surgery in children. The estimated incidence ranges from 1 to 6/10,000 between birth and 4 years of age and from 19 to 28/10,000 between 5 and 14 years of age. Boys are more frequently affected than girls. Obstruction of the appendiceal lumen is the first pathogenetic moment. The lack of physiologic washout of the lumen causes distension of the lumen, wall thickness, and bacterial overgrowth. Mucosal barrier is overwhelmed, leading to bacterial invasion of the wall, inflammation, ischemia, gangrene, and eventually perforation. The clinical presentation of acute appendicitis classically includes anorexia, periumbilical pain at the onset, migration of pain in the lower right quadrant, vomiting (after the pain onset), fever, right lower tenderness, and signs of peritoneal irritation. This classical pattern is less common in pediatric age. The risk of acute appendicitis can be estimated using the pediatric appendicitis score (PAS), and in doubtful cases, imaging can help the diagnosis. The treatment consists of appendectomy which should be performed laparoscopically (if available). Prognosis is excellent in most of the cases. Complications include wound infections, intra-abdominal abscesses, peritoneal adhesions, and stump appendicitis