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Acute appendicitis in children: Clinical manifestations and diagnosis

David E Wesson, MD
Section Editor
Jonathan I Singer, MD
Deputy Editor
James F Wiley, II, MD, MPH


Appendicitis is the most common condition in children requiring emergency abdominal surgery. The key to a successful outcome is early diagnosis followed by appendectomy before gangrene or perforation develops.

Older children and adolescents develop appendicitis more often than younger children and often have clinical features that are similar to those seen in adults. Younger children can be particularly difficult to diagnose because the presentation may be nonspecific, symptoms cannot be adequately expressed, and the child is often apprehensive and uncomfortable, making the evaluation challenging. Laboratory testing and imaging studies, primarily ultrasound and computed tomography or magnetic resonance imaging, are helpful adjuncts in selected children undergoing evaluation for appendicitis.

This topic will discuss the epidemiology, clinical features, and evaluation of children with suspected appendicitis. Detailed discussions of diagnostic imaging and treatment for pediatric appendicitis are found elsewhere. (See "Acute appendicitis in children: Diagnostic imaging" and "Acute appendicitis in children: Management".)


The appendix arises from the cecum, which is located in the right lower quadrant of the abdomen in the majority of children. It may lie in the upper abdomen or on the left side in children with congenital abnormalities of intestinal position (eg, uncorrected malrotation), situs inversus totalis, and after repair of diaphragmatic hernia, gastroschisis, and omphalocele [1].

Some anatomic features of the appendix may play a role in the incidence and presentation of appendicitis throughout childhood. These include the following [2]:


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Literature review current through: Sep 2016. | This topic last updated: Aug 30, 2016.
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