Synopsis
Recognise age-dependent appendicitis before perforation, use repeated clinical assessment and radiation-conscious imaging and deliver timely antibiotics, source control and recovery advice through paediatric surgical care.
- Ask pain onset, migration and progression, anorexia, vomiting sequence, stool, urine, fever and movement; examine chest, abdomen, groins and genitalia where indicated.
- Give analgesia and reassess; a child with peritoneal irritation often lies still and has pain with walking, coughing or gentle percussion.
- First-line diagnosis is clinical with serial paediatric surgical assessment; scoring systems can organise findings but do not replace judgement.
- Urinalysis, pregnancy testing and targeted FBC and CRP help evaluate mimics and severity, but normal markers cannot exclude early appendicitis.
- Ultrasound is preferred initial imaging in children; a visualised enlarged non-compressible appendix supports diagnosis, while non-visualisation is indeterminate.
- MRI is a radiation-free problem-solving option where available; CT is reserved for unresolved cases or complications when its benefit exceeds radiation risk.
- Suspected appendicitis requires same-day hospital and surgical assessment, nil by mouth, fluids as needed and no delay for outpatient imaging.
- Definitive management is usually laparoscopic appendicectomy with perioperative antibiotics; selected uncomplicated cases may use specialist non-operative protocols with recurrence discussion.
- Perforation, abscess or sepsis needs broad-spectrum IV antibiotics and source control tailored to collection and physiology.
Key red flags
Young children may present with lethargy, irritability, vomiting or diarrhoea and often perforate before classic migration is recognised.
Progressive pain moving from periumbilical region to right lower quadrant with anorexia and movement avoidance is characteristic but not mandatory.
Diffuse guarding, rigid abdomen, sepsis, persistent tachycardia or worsening after transient pain relief suggests perforation.
Testicular torsion, ovarian torsion and ectopic pregnancy are time-critical mimics of lower abdominal pain.
Neutropenia, immunosuppression and significant comorbidity alter inflammatory signs and antimicrobial and operative planning.
A non-visualised appendix on ultrasound does not exclude appendicitis when clinical probability remains high.
Investigation priorities
Assess progression, localisation, peritonism and response to analgesia in an evolving disease.
Visualise appendix and secondary inflammation without radiation and assess pelvic alternatives.
Management branches
Progressive focal pain or examination raises appendicitis concern.
- Provide analgesia, keep nil by mouth, obtain urine and targeted bloods and correct dehydration.
- Arrange same-day paediatric surgical assessment and ultrasound without outpatient delay.
- Use serial examination and second-line imaging when appendix is not visualised but probability persists.