Clinical Evaluation of Acute Appendicitis

One of the most common causes of surgical abdominal pain among children is appendicitis. History of present illness and physical examination are important in distinguishing appendicitis from other etiologies of abdominal pain, and surgical decisions can be made sometimes on these findings alone. The addition of laboratory results and various imaging modalities can help in equivocal cases. Ultrasound and computed tomography, and more recently magnetic resonance imaging, are beneficial in the diagnosis of acute appendicitis. The use of clinical practice guidelines also can be helpful in the triage and treatment of children with abdominal pain. Patients who present with history or physical examination findings concerning for appendicitis should be managed in a stepwise fashion to facilitate timing of imaging studies and surgical consultation. Management should include early resuscitation, appropriate laboratory testing and imaging studies, serial examinations, and early consultation of the surgical team in suspicious cases.