Acute appendicitis in children

Abstract

Acute appendicitis is the most common disease requiring surgery in pediatric patients. It can be classified into two groups: primary appendicitis and secondary appendicitis. Primary appendicitis is usually due to obstruction by fecal pellets and sometimes requires emergency surgery. In contrast, secondary appendicitis is due to spreading enteritis and does not necessarily require surgery. To adhere to the ALARA concept, sonography is the first-line modality to evaluate acute appendicitis in children. The following sonographic findings are useful for evaluating the severity of acute appendicitis: maximum diameter, wall thickness, loss of mural stratification, hyperemia, and peri-appendiceal fluid. While visualization of the normal appendix appears to be more difficult with sonography than CT, we suggest that, unless clinical symptoms warrant immediate surgery, patients with a non-visualized appendix on initial examination should be managed with active clinical observation and repeated sonography, rather than urgent CT scan as these patients are at a significantly lower risk for both perforated and nonperforated appendicitis.