When Appendicitis Is Suspected in

Children

Oleh :Dynna Akmal

Introduction

• 60,000–80,000 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 Assessmentof 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 studycontrast in appendix (CT)

Ultrasound: Normal AppendixLongitudinal ultrasonography shows compressible tubular structure with an outer diameter of less than 6 mm. A=Iliac artery; V=Iliac vein.

Normal Appendix: MR

Graded Compression Ultrasound

Figure 2. Acute appendicitis with target sign. TransverseUS scan through an inflamed appendix shows an intactechogenic 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 inflamedappendix 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) USscans 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 inflamedappendix demonstrate marked hyperemia along the periphery.

Acute appendicitis CT

Figure 16. Acute appendicitis. Axial CT scan obtainedthrough the lower abdomen with thin collimation followingthe intravenous and rectal administration of contrastmaterial demonstrates an enlarged appendix with markedstranding of the periappendiceal fat.

CT Appendicolith

(18) Acute appendicitis with an appendicolith.Axial CT scan obtained through the upper pelvis withthin collimation following the intravenous and rectal administrationof contrast material demonstrates an appendicolithwithin the appendix (arrow).

Periappendiceal Abscess

Figure 20. Perforated appendicitis. Axial CT scanobtained through the upper pelvis with thin collimationfollowing the intravenous and rectal administrationof contrast material demonstrates a complex masscontaining fluid and air representing a periappendicealabscess.