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World J Clin Pediatr. May 8, 2015; 4(2): 19-24
Published online May 8, 2015. doi: 10.5409/wjcp.v4.i2.19
Appendicitis in children less than five years old: A challenge for the general practitioner
Pierluigi Marzuillo, Claudio Germani, Baruch S Krauss, Egidio Barbi
Pierluigi Marzuillo, Department of Women and Children and General and Specialized Surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy
Claudio Germani, Egidio Barbi, Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
Baruch S Krauss, Boston Childrens Hospital, Boston, MA 02130, United States
Author contributions: Marzuillo P wrote the manuscript; Germani C supervised the manuscript drafting; Krauss BS critically revised and contributed to conceptually improve the manuscript; Barbi E conceived the manuscript.
Conflict-of-interest: Nothing to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pierluigi Marzuillo, MD, Department of Women and Children and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Via L. De Crecchio 2, 80138 Naples, Italy. pierluigi.marzuillo@gmail.com
Telephone: +39-389-4873353 Fax: +39-040-3785727
Received: November 2, 2014
Peer-review started: November 4, 2014
First decision: November 27, 2014
Revised: February 12, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: May 8, 2015
Abstract

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.

Keywords: Appendicitis, Children, Early diagnosis, Newborn, Appendicitis complications

Core tip: Acute appendicitis in the first years of life is an uncommon event but with a high incidence of early perforation the younger the patient. We highlight the epidemiology, pathophysiology, clinical signs, and laboratory clues of appendicitis in young children. The challenge for the practitioner is to perform a timely diagnosis of acute appendicitis in first years of life before complications occur.