Appendicitis in children less than five years old: A challenge for the general practitioner

Table 1 Conditions mimicking childhood and neonatal appendicitis (modified from ref.[8])

Condition	Diagnostic clues
Gastroenteritis	Continuous abdominal pain
	Poor clinical condition with mild or no dehydration, continuous, focal abdominal pain, and lack of movement in infants and young children distinguishes appendicitis from gastroenteritis Acute appendicitis is more common during viral epidemics and bacterial gastroenteritis[44]
Upper respiratory tract infection1	The presence of concomitant signs of upper respiratory infection are common in toddlers and does not rule out the possibility of appendicitis
Pneumonia	Basal pneumonia may mimic appendicitis pain[45] Simultaneous pneumococcal pneumonia and appendicitis is well reported in the literature[46]
Sepsis	An acute appendicitis should be suspected and ruled out in any case of sepsis associated with abdominal pain and or abdominal tenderness[47]
Urinary tract infection	Peritoneal inflammation may cause voiding disturbances and bladder symptoms[48]
Blunt abdominal trauma	Acute appendicitis may be associated with blunt abdominal trauma[49-51]
Intussception	Abdominal US is highly operator dependent In presence of fever, localized pain and guarding in infants and young children, appendicitis should be ruled out[52]
NEC	With a history of NEC outside prematurity and signs of abdominal cellulitis, neonatal appendicitis should be ruled out[53]

¹Includes diagnoses of otitis media, sinusitis, pharyngitis and upper respiratory tract infection. US: Ultrasonography; NEC: Necrotizing enterocolitis.