Appendicitis Diagnosis In Children

New diagnostic techniques are being developed to spare some children who might have appendicitis from having to go through CT scans. The scans use dangerous radiation, although in small amounts. However, while the danger posed by the radiation is small, the procedure is an expensive one. Hospitals only have a limited number of scanners, particularly scanners suitable for pediatric patients, and more patients being scanned means longer diagnostic times. In addition, the machines are large and loud, and can be frightening for children—especially children who are in pain—and the lying still required to get an accurate image can be difficult.

However, appendicitis can be difficult to diagnose without getting the direct look a CT scan provides. Other tests an rule out alternative diagnoses, but they aren’t definitive, and relying solely on eliminating other hypotheses could lead to unnecessary surgery. One alternative approach has been ultrasound, but while that doesn’t use radiation, it requires special training to interpret, and it is still expensive. Another approach, developed at the Mayo Clinic, uses an algorithm based on observable symptoms—such as the location and severity of the pain, the child’s appetite, and measured temperature—to distinguish likely cases of appendicitis from other possible causes of the symptoms. This approach allowed doctors to give less than half as many CT scans, while getting equally accurate diagnoses.

Appendicitis is important to recognize and treat right away, because left unchecked, the inflammation can lead to rupture, which can cause infection—sometimes fatal—in the abdominal cavity, a condition called peritonitis. The inflammation is usually due to a blockage of obstruction sealing off the appendix. This blockage may result from something called an appendicolith, or it can be caused by swollen lymph nodes or certain kinds of infection in the gut. When the appendix is blocked, it quickly becomes filled with mucus and blood flow to the tissue is cut off. This causes damage to the walls of the appendix, which draws bacteria. In all but the least complicated cases, treatment consists of surgery. Once the tissue has become damaged, removing the blockage does little to reduce risk of rupture, while removal of the appendix has no ill effects in most cases.

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