Early childhood appendicitis is still a difficult diagnosis

We report on 90 pre-school children operated on for suspected acute appendicitis. The data analysis was retrospective. The outcome of exploration was negative in 54% (49/90) of cases; inflamed nonperforated appendix was removed in 28% (25/90) and a perforated appendix in 18% (16/90) of cases. In infants aged <3 years (n = 26) the perforation rate was 60%, and in children aged 4-5 years (n = 64) it was 27%. Tenderness in the iliac fossa, blood leukocytosis and urinanalysis had little diagnostic value. Preoperative signs of diffuse peritonitis and elevated values of serum C-reactive protein were found more frequently only in the children with a perforated appendix. There was no mortality and the postoperative morbidity varied between 10 and 20%. Thus, although appendectomy is currently a safe procedure in children, more specific non-invasive diagnostic aids are still needed to reduce the number of negative explorations and the rate of perforation.