Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan

Gihad Alsaeed; Ali Alassiri; Tamer Rizk; Anas Alshamali; Suhib Alsaeed; Mohamed Aslaeed; Lama Bakri

doi:doi:10.11648/j.ajp.20230902.18

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Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan

Gihad Alsaeed, Ali Alassiri, Tamer Rizk, Anas Alshamali, Suhib Alsaeed, Mohamed Aslaeed, Lama Bakri

Published in American Journal of Pediatrics (Volume 9, Issue 2)

Received: 26 May 2023 Accepted: 12 June 2023 Published: 21 June 2023

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Abstract

Atypical appendicitis is not uncommon in pediatrics. Factors that are usually seen in such presentations include: Age less than five years, developmental delay, ectopic anatomic location of the appendix, subacute or chronic appendicitis, and symptomatic treatment in addition to early inconclusive investigations. Children with Autistic spectrum disorder often suffer from communication problems, which might affect their ability to deliver their complaints effectively. It is usually parent’s interpretation that physicians will rely on as they are the best to delineate minor changes of their children’s behavior and body language signs, so that a correct diagnosis may be reached. Atypical appendicitis is usually a delayed diagnosis with increased morbidity and mortality. In this paper we illustrate the possible causes of atypical appendicitis in childhood, and review its clinical presentation, radiologic findings, and management plan as mentioned in medical literature. We also present a rare case of subacute appendicitis in a 5 years old autistic girl with atypical presentation, misleading imaging features, and re-admission after successful laparoscopy. Our aim is to present the importance of clinical assessment and suggest an approach to improve practice regarding childhood appendicitis which can be an endless trap for both patients and practitioners.

Published in	American Journal of Pediatrics (Volume 9, Issue 2)
DOI	10.11648/j.ajp.20230902.18
Page(s)	98-103
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Appendicitis, Atypical, Complicated, Subacute, Chronic Appendicitis, Imaging, Laparoscopy, Developmental Delay, Autism

References

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[2]	Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007 Feb; 14 (2): 124-9. doi: 10.1197/j.aem.2006.08.009. Epub 2006 Dec 27. PMID: 17192449.
[3]	Brewster GS, Herbert ME, Hoffman JR. Medical myth: Analgesia should not be given to patients with an acute abdomen because it obscures the diagnosis. West J Med. 2000 Mar; 172 (3): 209-10. doi: 10.1136/ewjm.172.3.209. PMID: 10734818; PMCID: PMC1070812.
[4]	Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 2012; 344: e2156 doi: 10.1136/bmj.e2156. PMID: 22491789; PMCID: PMC3320713.
[5]	Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015; 313 (23): 2340–2348. doi: 10.1001/jama.2015.6154.
[6]	Zacharzewska-Gondek A, Szczurowska A, Guziński M, Sąsiadek M, Bladowska J. A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications. Pol J Radiol. 2019 Jan 4; 84: e1-e8. doi: 10.5114/pjr.2018.81158. PMID: 31019588; PMCID: PMC6479055.
[7]	Vaghela K, Shah B. Diagnosis of acute appendicitis using Clinical Alvarado Scoring System and Computed Tomography (CT) Criteria in patients attending Gujarat Adani Institute of Medical Science – a retrospective study. Pol J Radiol. 2017; 82: 726–730.
[8]	Wu J, Zhang T, Zhu Y, Gong N. Diagnostic value of ultrasound compared to CT in patients with suspected acute appendicitis. Int J Clin Exp Med. 2017; 10: 14377–14385.
[9]	Kim HC, Yang DM, Jin W. Identification of the normal appendix in healthy adults by 64-slice MDCT: The value of adding coronal reformation images. Br J Radiol. 2008; 81: 859–864.
[10]	Reeves, P. T., Susi, A., Hisle-Gorman, E. et al. Brief Report: Association of Complicated Appendicitis in Children with Autism Spectrum Disorders. J Autism Dev Disord 50, 4535–4540 (2020). https://doi.org/10.1007/s10803-020-04499-z
[11]	Chandrasegaram MD, Rothwell LA, An EI, Miller RJ. Pathologies of the appendix: a 10-year review of 4670 appendicectomy specimens. ANZ J Surg. 2012 Nov; 82 (11): 844-7. doi: 10.1111/j.1445-2197.2012.06185.x. Epub 2012 Aug 24. PMID: 22924871.
[12]	Cognitive delays are more likely to have CT scan rather than ultrasound to diagnose appendicitis; tend to have appendectomies at a younger age, https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/press-releases/2020/childrens-appendicitis-082120/ accessed on May 22, 2023.
[13]	Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology. 2006 Oct; 241 (1): 83-94. doi: 10.1148/radiol.2411050913. Epub 2006 Aug 23. PMID: 16928974.
[14]	Holm, N., Rømer, M. U., Markova, E. et al. Chronic appendicitis: two case reports. J Med Case Reports 16, 51 (2022). https://doi.org/10.1186/s13256-022-03273-2
[15]	Rao PM, Rhea JT, Novelline RA, McCabe CJ. The computed tomography appearance of recurrent and chronic appendicitis. Am J Emerg Med. 1998 Jan; 16 (1): 26-33. doi: 10.1016/s0735-6757(98)90060-2. PMID: 9451309.
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[18]	Gómez-Torres GA, Ortega-Gárcia OS, Gutierrez-López EG, Carballido-Murguía CA, Flores-Rios JA, López-Lizarraga CR, Bautista López CA, Ploneda-Valencia CF. A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review. Int J Surg Case Rep. 2017; 36: 46-49. doi: 10.1016/j.ijscr.2017.04.033. Epub 2017 May 15.
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[20]	Schwartz MZ, Tapper D, Solenberger RI. Management of perforated appendicitis in children. The controversy continues. Ann Surg. 1983 Apr; 197 (4): 407-11. doi: 10.1097/00000658-198304000-00005.

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APA Style

Gihad Alsaeed, Ali Alassiri, Tamer Rizk, Anas Alshamali, Suhib Alsaeed, et al. (2023). Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. American Journal of Pediatrics, 9(2), 98-103. https://doi.org/10.11648/j.ajp.20230902.18

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ACS Style

Gihad Alsaeed; Ali Alassiri; Tamer Rizk; Anas Alshamali; Suhib Alsaeed, et al. Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. Am. J. Pediatr. 2023, 9(2), 98-103. doi: 10.11648/j.ajp.20230902.18

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AMA Style

Gihad Alsaeed, Ali Alassiri, Tamer Rizk, Anas Alshamali, Suhib Alsaeed, et al. Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. Am J Pediatr. 2023;9(2):98-103. doi: 10.11648/j.ajp.20230902.18

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@article{10.11648/j.ajp.20230902.18,
  author = {Gihad Alsaeed and Ali Alassiri and Tamer Rizk and Anas Alshamali and Suhib Alsaeed and Mohamed Aslaeed and Lama Bakri},
  title = {Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {2},
  pages = {98-103},
  doi = {10.11648/j.ajp.20230902.18},
  url = {https://doi.org/10.11648/j.ajp.20230902.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230902.18},
  abstract = {Atypical appendicitis is not uncommon in pediatrics. Factors that are usually seen in such presentations include: Age less than five years, developmental delay, ectopic anatomic location of the appendix, subacute or chronic appendicitis, and symptomatic treatment in addition to early inconclusive investigations. Children with Autistic spectrum disorder often suffer from communication problems, which might affect their ability to deliver their complaints effectively. It is usually parent’s interpretation that physicians will rely on as they are the best to delineate minor changes of their children’s behavior and body language signs, so that a correct diagnosis may be reached. Atypical appendicitis is usually a delayed diagnosis with increased morbidity and mortality. In this paper we illustrate the possible causes of atypical appendicitis in childhood, and review its clinical presentation, radiologic findings, and management plan as mentioned in medical literature. We also present a rare case of subacute appendicitis in a 5 years old autistic girl with atypical presentation, misleading imaging features, and re-admission after successful laparoscopy. Our aim is to present the importance of clinical assessment and suggest an approach to improve practice regarding childhood appendicitis which can be an endless trap for both patients and practitioners.},
 year = {2023}
}

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TY  - JOUR
T1  - Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan
AU  - Gihad Alsaeed
AU  - Ali Alassiri
AU  - Tamer Rizk
AU  - Anas Alshamali
AU  - Suhib Alsaeed
AU  - Mohamed Aslaeed
AU  - Lama Bakri
Y1  - 2023/06/21
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230902.18
DO  - 10.11648/j.ajp.20230902.18
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 98
EP  - 103
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230902.18
AB  - Atypical appendicitis is not uncommon in pediatrics. Factors that are usually seen in such presentations include: Age less than five years, developmental delay, ectopic anatomic location of the appendix, subacute or chronic appendicitis, and symptomatic treatment in addition to early inconclusive investigations. Children with Autistic spectrum disorder often suffer from communication problems, which might affect their ability to deliver their complaints effectively. It is usually parent’s interpretation that physicians will rely on as they are the best to delineate minor changes of their children’s behavior and body language signs, so that a correct diagnosis may be reached. Atypical appendicitis is usually a delayed diagnosis with increased morbidity and mortality. In this paper we illustrate the possible causes of atypical appendicitis in childhood, and review its clinical presentation, radiologic findings, and management plan as mentioned in medical literature. We also present a rare case of subacute appendicitis in a 5 years old autistic girl with atypical presentation, misleading imaging features, and re-admission after successful laparoscopy. Our aim is to present the importance of clinical assessment and suggest an approach to improve practice regarding childhood appendicitis which can be an endless trap for both patients and practitioners.
VL  - 9
IS  - 2
ER  -

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Author Information

Gihad Alsaeed

Department of Pediatrics, Syrian Board of Medical Specialties (SBOMS), Dr Sulaiman Al-Habib Takhassusi Hospital, Riyadh, Saudi Arabia
Ali Alassiri

Department of Surgery, King Faisal Specialist Hospital and Research Center, Dr Sulaiman Al-Habib Takhassusi Hospital, Riyadh, Saudi Arabia
Tamer Rizk

Department of Pediatric Neurology, Saint John Regional Hospittal, Saint John, Canada
Anas Alshamali

Avicenna Children Hospital, Syrian Board of Medical Specialties (SBOMS), Idlib, Syria
Suhib Alsaeed

Faculty of Medicine and Surgery, Pavia University, Pavia, Italy
Mohamed Aslaeed

Department of Surgery, Freiburg University Hospital, Freiburg, Germany
Lama Bakri

Department of Pediatrics, Syrian Board of Medical Specialties (SBOMS), Dr Sulaiman Al-Habib Takhassusi Hospital, Riyadh, Saudi Arabia

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APA Style

Gihad Alsaeed, Ali Alassiri, Tamer Rizk, Anas Alshamali, Suhib Alsaeed, et al. (2023). Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. American Journal of Pediatrics, 9(2), 98-103. https://doi.org/10.11648/j.ajp.20230902.18

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ACS Style

Gihad Alsaeed; Ali Alassiri; Tamer Rizk; Anas Alshamali; Suhib Alsaeed, et al. Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. Am. J. Pediatr. 2023, 9(2), 98-103. doi: 10.11648/j.ajp.20230902.18

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AMA Style

Gihad Alsaeed, Ali Alassiri, Tamer Rizk, Anas Alshamali, Suhib Alsaeed, et al. Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan. Am J Pediatr. 2023;9(2):98-103. doi: 10.11648/j.ajp.20230902.18

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@article{10.11648/j.ajp.20230902.18,
  author = {Gihad Alsaeed and Ali Alassiri and Tamer Rizk and Anas Alshamali and Suhib Alsaeed and Mohamed Aslaeed and Lama Bakri},
  title = {Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {2},
  pages = {98-103},
  doi = {10.11648/j.ajp.20230902.18},
  url = {https://doi.org/10.11648/j.ajp.20230902.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230902.18},
  abstract = {Atypical appendicitis is not uncommon in pediatrics. Factors that are usually seen in such presentations include: Age less than five years, developmental delay, ectopic anatomic location of the appendix, subacute or chronic appendicitis, and symptomatic treatment in addition to early inconclusive investigations. Children with Autistic spectrum disorder often suffer from communication problems, which might affect their ability to deliver their complaints effectively. It is usually parent’s interpretation that physicians will rely on as they are the best to delineate minor changes of their children’s behavior and body language signs, so that a correct diagnosis may be reached. Atypical appendicitis is usually a delayed diagnosis with increased morbidity and mortality. In this paper we illustrate the possible causes of atypical appendicitis in childhood, and review its clinical presentation, radiologic findings, and management plan as mentioned in medical literature. We also present a rare case of subacute appendicitis in a 5 years old autistic girl with atypical presentation, misleading imaging features, and re-admission after successful laparoscopy. Our aim is to present the importance of clinical assessment and suggest an approach to improve practice regarding childhood appendicitis which can be an endless trap for both patients and practitioners.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Atypical Appendicitis in Children: Clinical Presentation, Imaging Features, and Management Plan
AU  - Gihad Alsaeed
AU  - Ali Alassiri
AU  - Tamer Rizk
AU  - Anas Alshamali
AU  - Suhib Alsaeed
AU  - Mohamed Aslaeed
AU  - Lama Bakri
Y1  - 2023/06/21
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230902.18
DO  - 10.11648/j.ajp.20230902.18
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 98
EP  - 103
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230902.18
AB  - Atypical appendicitis is not uncommon in pediatrics. Factors that are usually seen in such presentations include: Age less than five years, developmental delay, ectopic anatomic location of the appendix, subacute or chronic appendicitis, and symptomatic treatment in addition to early inconclusive investigations. Children with Autistic spectrum disorder often suffer from communication problems, which might affect their ability to deliver their complaints effectively. It is usually parent’s interpretation that physicians will rely on as they are the best to delineate minor changes of their children’s behavior and body language signs, so that a correct diagnosis may be reached. Atypical appendicitis is usually a delayed diagnosis with increased morbidity and mortality. In this paper we illustrate the possible causes of atypical appendicitis in childhood, and review its clinical presentation, radiologic findings, and management plan as mentioned in medical literature. We also present a rare case of subacute appendicitis in a 5 years old autistic girl with atypical presentation, misleading imaging features, and re-admission after successful laparoscopy. Our aim is to present the importance of clinical assessment and suggest an approach to improve practice regarding childhood appendicitis which can be an endless trap for both patients and practitioners.
VL  - 9
IS  - 2
ER  -

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