Acute Appendicitis

Acute Appendicitis
• Defined as an inflammation of the inner lining
of the vermiform appendix
• Most common acute surgical condition in
children and major cause of childhood
morbidity
 Clinical Presentation
• Abdominal pain
• Fever
• Nausea and vomiting
• Diarrhea
• Rebound tenderness
• Rovsing’s sign
• Obturator sign
• Psoas sign
 Diagnosis
• Hallmark of diagnosis is a thorough history
and physical examination
• Insidious onset
• Localized abdominal tenderness is the single
most reliable finding
 Diagnostic Studies
• CBC
– Elevated Leukocyte count
• Urinalysis
• Plain Radiograph
• Ultrasound
• CT Scan
 Pathophysiology
• Appendix becomes obstructed and becomes
distended
• Increased intraluminal and intramural
pressure
• Obstruction of venous drainage
• Congestion and ischemia
• Perforation
 Treatment
• Antibiotics
• Appendectomy
• Diagnostic laparoscopy and laparoscopic
appendectomy
 Prognosis
• Generally, the prognosis is excellent.
• At the time of diagnosis, the rate of
appendiceal perforation is 20-35%.
– The rate of perforation is 80-100% for children
younger than 3 years,
– 10-20% in children 10-17 years old.
• Mortality rate for children with appendicitis is
0.1-1%