Learning points
This case study illustrates a typical scenario of appendicitis.
This diagnosis should be considered in any child presenting
with acute AP.Typically, the pain of appendicitis:
■ Starts around the umbilicus, later radiating to the lowerright
abdomen
■ Causes tenderness and rebound effect in the lower-right
abdomen
■ Worsens when coughing or jumping
■ Is followed, not preceded, by vomiting
■ Often fluctuates in severity.
The diagnosis was initially uncertain as the child was
admitted for observation. Gastroenteritis and diabetic
ketoacidosis may mask appendicitis.The absence of diarrhoea
and polydipsia and polyuria in this case made both conditions
very unlikely. Lower-lobe pneumonia can also produce
AP-mimicking appendicitis. The child was however not
tachypnoeic and chest auscultation was normal.
A delay in the diagnosis of appendicitis may lead to appendix
perforation, as happened in this case. Children typically have
longer history of pain, greater systemic effect, high fever, more
generalised tenderness and minimal or absent bowel sounds.
Shock with reduced capillary refill time and low blood pressure
may ensue without circulatory support.
Differentiating surgical from non-surgical causes
History and physical examination are the key factors in
differentiating surgical from non-surgical causes ofAP (Ta