Appendicitis in children

Among children presenting to hospital with abdominal pain, acute appendicitis is common. The history is short in the majority. Where the diagnosis is in doubt, active observation and judicious investigation are appropriate. For confirmed cases and children in whom appendicitis is strongly suspected, surgery is the standard treatment though the child with an appendix mass can initially be managed conservatively. Adequate resuscitation and broad-spectrum antibiotics are important pre-operatively to ensure successful outcomes. Appendicectomy can be carried out open or laparoscopically. Laparoscopic appendicectomy is becoming the intervention of choice where facilities and expertise are available. Operating late at night and in the early hours of the morning is not recommended. Complications of the disease include rupture with localized or generalized peritonitis. Surgical and post-operative complications include injury to the bowel or the ureter which are both uncommon, but abscess formation is frequently seen. While acute appendicitis remains a cause of morbidity and occasionally mortality, with timely presentation the majority of children have a good outcome.