A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit

Kam L. Hon; Alexander K.C. Leung; Yan T.K. Lee; Stephanie Tsang; Karen K.Y. Leung; Wun F.A. Hui; Wing L. Cheung; Wai Y.M. Leung

doi:10.2174/1573396320666230811092837

ISSN: 1573-3963
E-ISSN: 1875-6336

A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit
Authors: Kam L. Hon¹, Alexander K.C. Leung², Yan T.K. Lee³, Stephanie Tsang³, Karen K.Y. Leung¹, Wun F.A. Hui¹, Wing L. Cheung¹ and Wai Y.M. Leung⁴
View Affiliations Hide Affiliations

Affiliations: ¹ Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong, China ; ² Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada T2M 0H5; ³ Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China ; ⁴ Department of Surgery, The Hong Kong Children’s Hospital, Hong Kong, China
Source: Current Pediatric Reviews, Volume 21, Issue 1, Jan 2025, p. 75 - 79
DOI: https://doi.org/10.2174/1573396320666230811092837
- Received: 15 Feb 2023
- Accepted: 13 Jun 2023
- Available online: 01 Jan 2025

Abstract

Introduction

Appendicitis is a common childhood condition that can be diagnostically challenging. Severe cases may necessitate support in the critical or intensive care unit. These “critical appendicitis diagnoses” have rarely been described.

Case Description

We retrospectively reviewed the Paediatric Intensive Care Unit (PICU) database of the Hong Kong Children’s Hospital and identified cases of suspected and confirmed appendicitis. Clinical features, radiologic findings and final diagnosis of each case were summarized and reported in this case series. We review six anonymized cases of appendicitis managed in a PICU to illustrate the different age spectrum and clinical manifestations of the condition. Rupture of the inflamed appendix, peritonitis and pancreatitis were some of the complications encountered. Crohn’s disease was found in one case as an underlying diagnosis. Also, one girl clinically diagnosed with appendicitis was found to be a case of ruptured hepatoblastoma with no appendicitis (i.e., pseudo-appendicitis).

Conclusion

Prompt diagnosis, surgical removal of the inflamed appendix, and use of appropriate antimicrobials when indicated are essential in reducing mortality and morbidity associated with severe appendicitis. Significant premorbid conditions such as acute myeloid leukemia, Mitochondrial Encephalopathy Lactic Acidosis Syndrome (MELAS), inflammatory bowel disease and complications may be present in patients needing intensive care as is illustrated in the present cases. Pseudo-appendicitis is an important differential diagnosis. Imaging is crucial and useful in establishing and confirming the diagnosis of appendicitis and pseudo-appendicitis in these PICU cases.

Article metrics loading...

/content/journals/cpr/10.2174/1573396320666230811092837

2025-01-01

2024-11-01

From This Site

/content/journals/cpr/10.2174/1573396320666230811092837

dcterms_title,dcterms_subject,pub_keyword

-contentType:Contributor -contentType:Concept -contentType:Institution

10

5

Full text loading...

References

StringerM.D. Acute appendicitis.J. Paediatr. Child Health201753111071107610.1111/jpc.13737 29044790
[Google Scholar]
SchokT. SimonsP.C.G. Janssen-HeijnenM.L.G. PetersN.A.L.R. KonstenJ.L.M. Prospective evaluation of the added value of imaging within the dutch national diagnostic appendicitis guideline-do we forget our clinical eye?Dig. Surg.201431643644310.1159/000369587 25592145
[Google Scholar]
PaulsonE.K. KaladyM.F. PappasT.N. Suspected appendicitis.N. Engl. J. Med.2003348323624210.1056/NEJMcp013351 12529465
[Google Scholar]
BakkerO.J. GoP.M.N.Y.H. PuylaertJ.B.C.M. KazemierG. HeijH.A. Guideline on diagnosis and treatment of acute appendicitis: Imaging prior to appendectomy is recommended.Ned. Tijdschr. Geneeskd.2010154A303
[Google Scholar]
SaverioS.D. PoddaM. SimoneB.D. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines.World J. Emerg. Surg.202015127
[Google Scholar]
WonskiS. RanzenbergerL.R. CarterK.R. Appendix imaging.In: StatPearls.Treasure Island, (FL)StatPearls Publishing2023
[Google Scholar]
ShogilevD. DuusN. OdomS. ShapiroN. Diagnosing appendicitis: Evidence-based review of the diagnostic approach in 2014.West. J. Emerg. Med.201415785987110.5811/westjem.2014.9.21568 25493136
[Google Scholar]
TerasawaT. BlackmoreC.C. BentS. KohlwesR.J. Systematic review: Computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents.Ann. Intern. Med.2004141753754610.7326/0003‑4819‑141‑7‑200410050‑00011 15466771
[Google Scholar]
BundyD.G. ByerleyJ.S. LilesE.A. PerrinE.M. KatznelsonJ. RiceH.E. Does this child have appendicitis?JAMA2007298443845110.1001/jama.298.4.438 17652298
[Google Scholar]
KrishnamoorthiR. RamarajanN. WangN.E. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: Reducing radiation exposure in the age of ALARA.Radiology20112591231239
[Google Scholar]
WanM.J. KrahnM. UngarW.J. Acute appendicitis in young children: Cost-effectiveness of US versus CT in diagnosis - a Markov decision analytic model.Radiology20092502378386
[Google Scholar]
LeungA.K.C. BarankinB. LeongK.F. Henoch-Schönlein Purpura in Children: An updated review.Curr. Pediatr. Rev.202016426527610.2174/18756336MTA2lNDYc2 32384035
[Google Scholar]
LeungA.K.C. WongA.H.C. LeungA.A.M. HonK.L. Urinary tract infection in children.Recent Pat. Inflamm. Allergy Drug Discov.201913121810.2174/1872213X13666181228154940 30592257
[Google Scholar]
LeungA.K.C. SigaletD.L. Acute abdominal pain in children.Am. Fam. Physician671123212326
[Google Scholar]
ArabiR.I. AljudaibiA. ShafeiB.A. AlKholiH.M. SalemM.E. EibaniK.A. Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis - Case report.Int. J. Surg. Case Rep.201963808410.1016/j.ijscr.2019.09.001 31585327
[Google Scholar]
Pseudoappendicitis. In: StatPearls.Treasure Island, FLStatPearls Publishing2023
[Google Scholar]
ShommuN.S. BlackwoodJ. JenneC.N. Metabolomics and inflammatory mediator profiling for the differentiation of life-threatening and non-severe appendicitis in the pediatric population.Metabolites2021111066410.3390/metabo11100664 34677379
[Google Scholar]
ShommuN.S. JenneC.N. BlackwoodJ. The use of metabolomics and inflammatory mediator profiling provides a novel approach to identifying pediatric appendicitis in the emergency department.Sci. Rep.201881408310.1038/s41598‑018‑22338‑1 29511263
[Google Scholar]
ShommuN.S. JenneC.N. BlackwoodJ. Metabolomic and inflammatory mediator based biomarker profiling as a potential novel method to aid pediatric appendicitis identification.PLoS One2018133e019356310.1371/journal.pone.0193563 29529041
[Google Scholar]
WongC.W.J. ChungP.H.J. LanL.C.L. WongK.K.Y. Acute appendicitis presenting as pneumoperitoneum in a teenage boy undergoing chemotherapy.BMJ Case Rep.20152015Oct6
[Google Scholar]
HowellE.C. DubinaE.D. LeeS.L. Perforation risk in pediatric appendicitis: Assessment and management.Pediatric Health Med. Ther.2018913514510.2147/PHMT.S155302
[Google Scholar]