Appendicitis in children can be difficult to spot, delays raise complication risk: Doctors

Appendicitis in children can be difficult to recognise in its early stages as its symptoms may resemble those of common stomach infections but delays in diagnosis can significantly increase the risk of appendix perforation and other complications doctors saidThey said abdominal pain accompanied by vomiting fever loss of appetite or increasing tenderness should not be dismissed as a routine stomach infection particularly when the pain persists or becomes progressively severeAppendicitis in children usually presents with typical symptoms and signs which are apparent to a discerning doctor Dr Sandeep Agarwala Head of Department of Paediatric Surgery at AIIMS Delhi saidHowever it does not always present in the textbook manner A child usually has a vague central abdominal pain which in a few hours localises to the right lower abdomen When this is associated with or preceded by loss of appetite nausea and vomiting or fever one should have a high index of suspicion of appendicitis Dr Agarwala saidAppendicitis can frequently be mistaken for gastroenteritis which typically has diarrhoea as a main symptom Agarwala saidThe important point is to watch how the symptoms evolve and seek medical evaluation when the pain persists or worsens he saidYounger children pose a particular diagnostic challenge as they may not be able to clearly describe or localise their pain he saidIn them the diagnosis can be delayed and therefore complications like perforation may be higher Agarwala saidAccording to Dr Shandip Kumar Sinha Director of Paediatric Surgery and Paediatric Urology at Medanta The Medicity in Gurugram parents may initially assume that the child has a stomach infection and wait for the symptoms to settle but appendicitis can progress and in young children the progression may be fasterPersistent abdominal pain particularly when associated with fever vomiting or refusal to eat warrants medical assessment he said adding that the consequences of delayed diagnosis have also been highlighted in larger studiesHe said appendicitis may begin with pain around the navel before shifting towards the lower right side although this pattern is not seen in every child Nausea vomiting fever and loss of appetite are also common symptomsDiagnosis should be based on the childs symptoms and physical examination supported by investigations when required Ultrasound can be particularly useful in children because it does not involve radiation but an inconclusive scan should not provide false reassurance if clinical suspicion remains high Dr Sinha saidImaging decisions need to be individualised with ultrasound commonly used in children and further imaging considered when the clinical picture and initial findings do not match he saidAgarwala said that once appendicitis is confirmed surgical removal of the appendix remains a standard treatment in cases of acute appendicitis even when associated with perforation and peritonitisThe presence of a localised abscess in the right lower abdomen may mandate initial drainage of the abscess followed by delayed or interval appendicitisDevelopment of such complications does require more intensive management and may be associated with higher complications and prolonged hospitalisation Agarwala saidOccasionally early appendicitis may be managed nonsurgically with surgery performed later on an elective basis he statedDoctors advised parents to seek urgent medical attention from a paediatrician or paediatric surgeon if abdominal pain is persistent or worsening particularly when accompanied by repeated vomiting fever increasing abdominal tenderness refusal to eat or drink unusual lethargy or pain aggravated by movementThe intensity of pain alone should not determine whether a child needs evaluation A child can have appendicitis even when the initial symptoms are relatively mild Persistence and progression of symptoms are important warning signs Agarwala saidDr Prabudh Goel professor of Paediatric Surgery at AIIMS Delhi stressed that not every episode of abdominal pain is appendicitis but persistent or progressively worsening symptoms should be assessed by a medical professionalThe objective is not to alarm parents but to ensure that a potentially serious surgical condition is not missed because its early symptoms resemble a common childhood illness Timely diagnosis and treatment can prevent avoidable complications he saidThis story has been sourced from a third party syndicated feed agencies Midday accepts no responsibility or liability for its dependability trustworthiness reliability and data of the text Midday managementmiddaycom reserves the sole right to alter delete or remove without notice the content in its absolute discretion for any reason whatsoever