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

A norexia

N ausea and vomiting

T enderness in right lower

quadrant

R ebound pain

E levated temperature

L eukocytosis

S hift of white blood cell count to

left

Total

10

Complications of Appendicitis

Perforation
Abscess formation
Generalized peritonitis
Small bowel obstruction

Anatomy

Normal Appendix

contrast-filled appendix on barium

study

contrast in appendix (CT)

Ultrasound: Normal Appendix

Longitudinal 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. 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.