Emedicine article on paediatric appendicitis

Acute appendicitis is one of the most common causes of abdominal pain and the most frequent condition leading to emergent abdominal surgery in children.


  • Obstruction of appendix due to lymphoid hyperplasia or a faecolith

  • Leads to ischemia due to vascular compression, thus to bacterial overgrowth

  • Then to inflammation and possible rupture

  • Process = 72 hrs

  • Post-rupture peritonitis


  • Vague periumbilical pain, followed by nausea, vomiting, and anorexia

  • Pain moves to lower right quadrant

  • Perforation gives transitory relief, followed by more generalised pain

  • Nausea and vomiting generally rare, but more common with retrocecal appendices as they irritate the duodenum

  • Diarrhoea also uncommon except with a pelvic location which causes irritative stimulation of the rectum (usually not true diarrhoea)

  • Severe fever is uncommon and some patients may be afebrile


  • Discomfort

  • Withdrawn, unmoving

  • Patients are often dehydrated or in pain and may be tachycardic or tachypneic

  • Typically, maximal tenderness can be found at the McBurney point in the right lower quadrant. However, the appendix may lie in many positions.

      • A medially positioned appendix may present as suprapubic tenderness.

      • Patients with a laterally positioned appendix often have flank tenderness.

      • Patients with a retrocecal appendix may not have any tenderness until it is advanced or perforated.

    • Involuntary guarding of the rectus or oblique muscles

    • Rovsing sign / psoas sign / obturator sign

    • Should always perform rectal exam

      • Right-sided tenderness of the rectum is the classic finding in pelvic appendicitis or in pus that pools in the pelvis from an inflamed appendix elsewhere in the abdomen

Differential diagnoses