When Appendicitis Is Suspected in

Children

Oleh :
Dynna Akmal
 Introduction

60,00080,000 cases annually in the United

States.
It is one of the major causes of hospitalization
in children.
It is rare under the age of 2 years.
 Clinical Assessment
of Acute Appendicitis

Crampy
Periumbilical or right lower quadrant pain
Nausea
Vomiting
Leukocytosis with a left shift
 The MANTRELS Score
Characteristic Points
M igration of pain to right lower quadrant 1
A norexia 1
N ausea and vomiting 1
T enderness in right lower quadrant 2
R ebound pain 1
E levated temperature 1
L eukocytosis 2
S hift of white blood cell count to left 1
Total 10
 Complications of Appendicitis

Perforation
Abscess formation
Generalized peritonitis
Small bowel obstruction
Anatomy
 Normal Appendix

contrast-filled appendix on barium contrast in appendix (CT)

study
Ultrasound: Normal Appendix Normal Appendix: MR
Longitudinal ultrasonography shows compressible
tubular structure with an outer diameter of less
than 6 mm. A=Iliac artery; V=Iliac vein.
Graded Compression Ultrasound

Figure 2. Acute appendicitis with target sign. Transverse

US scan through an inflamed appendix shows an intact
echogenic submucosal layer and a fluid-filled lumen
(F), resulting in a target appearance.
 Appendicolith on US

Figure 3. Acute appendicitis with an appendicolith. Longitudinal (a) and transverse (b) US scans through
an inflamed
appendix show an echogenic appendicolith with acoustic shadowing.
 Perforated Appendix on US

Figure 5. Acute appendicitis with loss of the echogenic submucosal layer. Longitudinal (a) and transverse (b) US
scans through an inflamed appendix show a diffuse hypoechoic and enlarged appendix (between electronic calipers),
with loss of the normally echogenic submucosal layer. At surgery, appendiceal perforation was noted.
 Color Doppler Ultrasound

Figure 8. Acute appendicitis at color Doppler US. Longitudinal (a) and transverse (b) US
images through an inflamed
appendix demonstrate marked hyperemia along the periphery.
 Acute appendicitis CT

Figure 16. Acute appendicitis. Axial CT scan obtained

through the lower abdomen with thin collimation following
the intravenous and rectal administration of contrast
material demonstrates an enlarged appendix with marked
stranding of the periappendiceal fat.
 CT Appendicolith

(18) Acute appendicitis with an appendicolith.

Axial CT scan obtained through the upper pelvis with
thin collimation following the intravenous and rectal administration
of contrast material demonstrates an appendicolith
within the appendix (arrow).
 Periappendiceal Abscess

Figure 20. Perforated appendicitis. Axial CT scan

obtained through the upper pelvis with thin collimation
following the intravenous and rectal administration
of contrast material demonstrates a complex mass
containing fluid and air representing a periappendiceal
abscess.