Adarsh P. Shah, Peter Schnatterbeck, Colin Michie



Acute appendicitis and acute non-specific abdominal pain account for 95% of cases in children presenting with acute abdominal pain (Hayes, 2004). During the 2008-2009 financial year in the UK, there were over 34,000 cases of acute appendicitis, and 97% of procedures and interventions on the appendix were emergency appendicectomies [HES online]. Therefore, appendicitis is the most common abdominal emergency (Humes & Simpson, 2006) and approximately 20% of patients are aged between 0-14 years [HES Online]. History and clinical examination currently remains the mainstay of diagnosis. In cases of suspected acute appendicitis, imaging either in the form of ultrasonography (US) or computed tomography (CT), aims to reduce negative appendicectomies and perforation rates by enabling the establishment of a prompt diagnosis (Rosendahl et al., 2004). This article aims to describe the role of US as a first-choice imaging modality in cases of suspected acute appendicitis within the paediatric population.

Presenting features in suspected cases of acute appendicitis

Adults and older children present with the characteristic triad of clinical features – abdominal pain, low-grade fever and tenderness with guarding in the right iliac fossa (Acheson & Banerjee, 2010). Nance et al., (2000) observed that 94% of young children presented with pain as the main symptom, while tenderness (diffuse or focal) and guarding were the most common presenting signs. However, infants are more likely to have a history of recent respiratory infection followed by poor feeding, vomiting, abdominal distension, irritability, grunting, right hip pain with or without limp and high fever (Acheson & Banerjee, 2010). Perforation instead of abdominal pain may be the presenting feature in infants. A higher rate of perforation has been shown to be associated with younger age, and while there is an increased likelihood of the youngest patients presenting with perforation (Nance et al., 2000, Colvin et al., 2007).


Full Text:



  • There are currently no refbacks.