Appendicitis in preschool children

Appendicitis in preschool children, although uncommon, is associated with a high perforation rate and increased morbidity. Of 132 preschool children treated for appendicitis over a 5-year period, 63 (47.7%) had perforations and 29 (22.0%) had an appendiceal mass. Although classic symptoms were present in the majority of the patients, atypical symptoms were found in many children and included diarrhoea (35), cough/sore throat (15), dysuria (4), headache (2), and earache (2). A diagnosis other than appendicitis was suspected by attending medical practitioners in 53 (40%) patients, leading to delay in management. Mean duration of symptoms before admission was as follows: acute appendicitis 38.9 h, perforation 52.6 h, and appendix mass 81.7 h. Ten (7.6%) patients developed postoperative complications that included wound infection in 5, intra-abdominal abscess in 4, and adhesive intestinal obstruction in 1. A high index of suspicion of appendicitis is necessary in preschool children in view of the atypical presentation and high incidence of advanced appendicitis and morbidity.