Update: December 2018
Appendicitis is one of the most common surgical procedures.
abdominal pathologies caused by inflammation
of the appendix – the vermiform process of the caecum. Disease
needs emergency surgical treatment. In this article, we
tell you what signs of appendicitis can be in children.
Types of appendicitis
Depending on the course of appendicitis, there are two main
type – acute and chronic. Clinical anatomical classification
appendicitis in children includes the following varieties:
- catarrhal appendicitis is the simplest and most common
a common form of the disease. At the same time, swelling and
hyperemia of the appendix mucosa only, accumulation of serous
exudate in the abdominal cavity.
- phlegmonous appendicitis – accompanied by inflammation of all layers
process, its cavity contains pus, and the surface is covered with spots
- gangrenous appendicitis – proceeds with necrosis of the walls
- empyema appendix – empyema of the appendix
accompanied by accumulation of pus in its lumen
- perforated appendicitis – accompanied by rupture of the wall
appendix and outflow of its contents into the abdominal cavity.
Symptoms of appendicitis in children
Acute appendicitis in children can be at any age, however,
чаще всего он регистрируется в 5-14 лет, мальчики болеют в 2
times less than girls. In children, unlike adults,
symptomatology of appendicitis has some features that
due to the structure of the appendix and the weak development of its lymphoid
tissue. In children, the vermiform process is often located
retrocecal (behind the cecum) and subhepatic, as
causes a special picture of the disease.
The main signs of appendicitis in children:
- abdominal pains of different localization (depending on the location
- signs of anxiety (sleep disturbance, refusal to eat, crying)
- high temperature rise
- tachycardia (increased heart rate)
- disturbed stools (constipation, diarrhea)
- abdominal distention
- urination disorder
In children, appendicitis has a sudden onset and rapidly
increasing symptoms. There are sharp aching pains that
as in adults, most often begin in the epigastric region, and
then descend to their typical place – right ileal
region (typical of the typical location of the wormlike
A research team in Madrid conducted a study
3000 clinical cases of acute appendicitis and found that in
40% of cases in the hospital received patients who consumed the day before
chips or fried sunflower seeds, especially often
registered in adolescents under 14 years.
If the appendix is atypical, for example:
- retrocecal (behind the cecum) – pain in the area
loins extending to the groin;
- with pelvic localization of the appendix – pain is noted in the lower
parts of the abdomen and over the pubis;
- with subhepatic localization of the appendix – pain in the area
Sometimes pain in children can have a rare localization – to give in
back, perineum and genitals, ureter, stomach, that
makes it difficult to diagnose the disease (see appendicitis symptoms in
Patients with appendicitis, children often take forced lying
position, often on the left side with legs on the stomach (such
the position makes the pain moderate as the tension decreases
peritoneum and mesentery). Children are not allowed to touch their belly,
obstruct the survey, so it is best to examine them during
physiological or drug sleep time.
Small children cannot indicate the presence of pain, they exhibit
sheer anxiety – crying, screaming, refusing food and sleep. AT
moments when children calm down, they lie, not moving in one
position Their face is red, their tongues are coated with white bloom,
tachycardia, a rise in temperature, sometimes reaching
38 degrees and above (especially in young children). Older children
there is a discrepancy between pulse and temperature – a symptom
Одним из признаков аппендицита у ребенка является vomiting, она
may be different – single or multiple, but in any
case does not bring the child relief. In small children (up to 3 years)
appendicitis may manifest soreness when urinating.
When examining a child who is suspected
typical appendicitis, most of the symptoms characteristic of
diagnosis of appendicitis in adults are also positive: a symptom
Schetkina — Blumberg, Razdolsky, Sitkovsky, Rovsing. In children with
retrocecal localization of appendicitis tension of the abdominal muscles and
pain on palpation less pronounced symptom
Shchetkin-Blumberg may be negative. With pelvic appendicitis
the clinical picture can also be erased, however
informativity has a rectal examination in which
If you experience pain in the abdomen of a child can not be alone
start any treatment without determining its cause occurrences
be sure to call a doctor. There are several ways
suspect appendicitis in children over 7 years old, which can
осторожно произвести to parents до приезда врача:
- If the child coughs loudly, then the pain in the right ileal
areas will increase – this may be a symptom of appendicitis.
- Characteristic of appendicitis is also such a symptom – with
turning the child on the left side from the back, then there is an increase
pain in the right iliac region
- If the child is lying on the right side, he will tighten his legs to the body and
the pain will decrease – this can be a sign of appendicitis. And then
this will straighten your legs and turn to your left side, then the pain
- You can not feel the belly with your fingers, for a child is
can be very dangerous. To compare the pain in the right and left
ileal area is possible only a light tapping with a small pad
finger, if in the left side the child feels pain, but not in the right
– it can also be a symptom of appendicitis in a child.
Such a self-test can only be done in order to
in case of serious suspicion, immediately call an ambulance. With
diagnosis – acute appendicitis, emergency is shown
surgery, this is not a complicated surgical procedure, usually through
week baby is discharged.
US scientists consider ultrasound the most ineffective method
diagnosis of appendicitis, especially in children, because it leads to
frequent diagnostic errors, offering to replace it with CT.
However, computed tomography for children is not safe because
frequent radiation exposure increases the risk of cancer
children more than adults, especially tumors
brain and leukemia. But with dubious symptoms and
unspecified diagnosis of suspected appendicitis in a child or
brain hemorrhage – CT can save his life, so always
risks should be correctly assessed.
What provokes to unscrew the appendicitis in a child? Provoking
The factors causing inflammation can be many: infection in
vermiform process, dysfunction of the gastrointestinal tract, anatomical
features of the location of the process, less often the cause is
penetration into the process of foreign bodies. Connections of inflammation
appendicitis and lifestyle of a child, physical exertion or
hereditary location is not installed.
What not to do if you suspect appendicitis? With жалобах
child’s pain, the natural behavior of parents – give the child
pain reliever. This should not be done, because the reduction of pain
complicate the diagnosis. Also, you can not warm the belly, to offer
child warmer, it will lead to increased inflammation and only
worsen the condition of the child.
Differential diagnosis of appendicitis in children from others
Pediatric differential diagnosis of acute appendicitis
carry out with such diseases:
- ОРATИ (острые респираторные вирусные инфекции)
- gastrointestinal tract diseases
- urological diseases
- measles, rubella, hepatitis, chickenpox, scarlet fever (also
characterized by abdominal pain)
Respiratory infections in young children (how to distinguish
flu, orvi for colds), as well as appendicitis, can manifest
abdominal pain, vomiting and fever. However they
accompanied by corresponding changes in the mucous membranes of the nose and
throat, presence of discharge from the nose, conjunctivitis symptoms.
The distinctive symptom of appendicitis in a child is
abdominal syndrome, painful palpation of the abdomen, there is
passive tension of his muscles.
Pneumonia is a pathology that can be accompanied
abdominal pains imitating appendicitis. AT таких случаях важна
process dynamics. Pneumonia is accompanied by increasing shortness of breath,
cyanosis of the nasolabial triangle, with time over the lungs
there are moist rales, weakening of breath, which is not the case
appendicitis. The diagnosis is confirmed by x-ray results, on
which signs of pneumonia are visible to the naked eye.
Otitis in children (especially small ones) can also imitate
picture of appendicitis. They, too, are restless, cry and sleep poorly.
Однако при otitisе у детей абсолютно безболезненный живот, нет
the tension of his muscles. Надавливание же на козелок уха при otitisе
causes baby crying and anxiety.
Invagination unlike appendicitis has more pronounced
symptoms: sharp abdominal pain, discharge of blood from the rectum.
With пальпации живота отсутствует напряжение мышц живота и симптомы
irritation of the peritoneum. The diagnosis of invagination is confirmed
X-ray examination of the abdominal cavity.