Appendicitis and non-specific abdominal pain in children

Abdominal pain in children is common and sometimes results from serious pathology amenable to surgical intervention. Though the true cause of many symptoms is not always determinable a diagnostic label is often assigned. The final diagnosis for many children is ‘non-specific abdominal pain’ – an ill-understood group of conditions. Acute appendicitis is common in children and can be life threatening; the history is short in the majority and the diagnosis can be obvious, but when the diagnosis is in doubt, active observation and judicious investigation are appropriate. For children in whom appendicitis is strongly suspected, surgery is the standard treatment though the child with an appendix mass may be managed conservatively. Adequate resuscitation and preoperative broad-spectrum antibiotics are important for successful outcomes.Appendicectomy can be carried out open or laparoscopically. Laparoscopic appendicectomy is the intervention of choice where facilities and expertise are available. Operating late at night is not recommended. Complications of the disease include rupture with localized or generalized peritonitis leading to intra-abdominal and pelvic abscesses, and wound infections. Rarely there may be an iatrogenic injury to the bowel or an appendix stump rupture resulting in a faecal fistula. While acute appendicitis remains a cause of morbidity and occasionally mortality, with timely presentation the majority of children have a good outcome.