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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


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]:

In the first year of life, the appendix is funnel-shaped, perhaps making it less likely to become obstructed.

Lymphoid follicles are interspersed in the colonic epithelium that lines the appendix and may obstruct it. These follicles reach their maximal size during adolescence, the age group in which the peak incidence of appendicitis occurs.

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Literature review current through: Nov 2017. | This topic last updated: Sep 06, 2017.
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