Appendicitis

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Overview, Causes, & Risk Factors

Appendicitis is one of the most common causes of emergency abdominal surgery in children. Approximately 4 appendectomies per 1,000 children are done annually in the United States.

Appendicitis is more common in males than in females, and incidence peaks in the late teens and early 20s. The condition is uncommon among children younger than 2, but it can occur.

Appendicitis generally follows obstruction of the appendix by feces (fecalith), a foreign body, or rarely, a tumor. Typically, the first symptom is crampy or "colicky" pain around the navel (periumbilical). There is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low grade fever.

As the inflammation in the appendix increases, the pain tends to move downward and to the right (right lower quadrant) and localizes directly above the position of the appendix at a point called "McBurney's point." If a line is drawn from the navel to the prominence on the right pelvic bone (right superior iliac crest) and divided into thirds, McBurney's point is two-thirds of the line from the navel.

Pressing the abdomen at McBurney's point causes tenderness in a patient with appendicitis. When the abdomen is pressed, held momentarily, and then rapidly released, the patient may experience a momentary increase in pain. This "rebound tenderness" suggests inflammation has spread to the peritoneum.

If the appendix ruptures, the pain may disappear for a short period and the patient may feel suddenly better. However, once peritonitis sets in, the pain returns and the patient becomes progressively more ill. At this time the abdomen may become rigid and extremely tender.

Symptoms of appendicitis in young children are seldom typical, so diagnosis is commonly delayed and perforation more likely. Older children, adolescents, and adults are more easily diagnosed.