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The following is a summary of “Diagnostic challenges of acute appendicitis in preschool children: A comprehensive case-control study,” published in the December 2024 issue of Pediatrics by Paran et al.  

Acute appendicitis is a common pediatric emergency but presents diagnostic challenges in preschool children due to atypical symptoms.  

Researchers conducted a retrospective study evaluating the distinct characteristics of acute appendicitis in preschool and school-aged children.  

They included children under 5 years and a control group of children aged 5 to 10 years who underwent surgery for acute appendicitis (2009 and 2022). Data were collected on demographics, clinical presentation, laboratory results, imaging, surgical procedure, pathology, bacteriology, antibiotic treatment, length of stay, and outcomes.  

The results showed that preschool children were presented less frequently with abdominal pain but more often with vomiting, diarrhea, and fever. Lower rates of leukocytosis were observed, but higher rates of thrombocytosis and C-reactive protein. Younger children were more likely to undergo both chest and abdominal X-rays and were admitted to pediatric departments before a diagnosis of appendicitis was made. Complicated appendicitis, requiring intraoperative drain placement, and conversions to open procedures were more common in preschool children. They also had higher rates of intensive care unit (ICU) admission and surgical complications. Polymicrobial positive cultures and positive cultures for Bacteroides were more common in preschool children.  

They concluded that healthcare providers must be aware of the atypical presentations of acute appendicitis in preschool children to improve diagnostic accuracy and management.  

Source: onlinelibrary.wiley.com/doi/abs/10.1111/jpc.16748