Acute Appendicitis in Pediatric Patients: An Updated Narrative Review

Abstract

Acute appendicitis is the most common pediatric surgical emergency worldwide. The diagnosis and management in children involves a unique set of challenges for clinicians. While the diagnosis is primarily clinical, utilization of imaging and laboratory studies can aid practitioners in making a more prompt diagnosis, preventing complications from appendiceal perforation and limiting the rate of negative appendectomies. In children special emphasis has been placed on minimizing ionizing radiation exposure, and thus multiple imaging modalities have been employed to aid in diagnosis including MRI and ultrasound. Additionally, several algorithms have been developed to stratify patients into low, intermediate, and high-risk categories for acute appendicitis. Once diagnosed, treatment of acute appendicitis is distinguished between simple appendicitis which is most often treated with laparoscopic removal, and complex appendicitis with perforation which may be treated with primary surgical resection or percutaneous drainage with interval appendectomy. Recently, there is a resurgent interest in treating simple appendicitis with antibiotics. We will examine the evidence for all and discuss potential future directions.