Pediatric Appendicitis Differential Diagnoses

Author: Robert K Minkes, MD, PhD; Chief Editor: Carmen Cuffari, MD more...

Updated: Oct 26, 2011

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Diagnostic Considerations

Do not diagnose gastroenteritis rather than appendicitis unless the patient has nausea, vomiting, and diarrhea. Even with the presence of vomiting and diarrhea, consider the unusual presentations of retrocecal or pelvic appendicitis. Additionally, appendicitis can develop as a sequela of gastroenteritis associated with lymphoid hyperplasia.

Diagnose abdominal pain of unknown etiology in patients with nonspecific abdominal symptoms. Instruct patients to be reevaluated in 8-12 hours by their primary care physician or to return to the emergency department. Patients with equivocal examination findings should be admitted for observation for serial abdominal examinations or to undergo imaging with ultrasonography or abdominal CT scanning.

If constipation is diagnosed and treated with enemas and/or stool softeners with resolution of the signs and symptoms, inform the patient and family that recurrence of the abdominal pain in the future could be recurrent constipation or acute appendicitis and to seek medical advice.

Appendicitis should be considered in special patient populations, such as the immunocompromised and developmentally delayed. Appendicitis is rare in infants. If an infant has appendicitis, the diagnosis of Hirschsprung disease should also be considered.

Other problems to consider include the following:

Ovarian cyst
Ovarian torsion
Pelvic inflammatory disease (PID)
Pregnancy
Ectopic pregnancy
Renal calculi
Mesenteric lymphadenitis
Mittelschmerz
Pneumonia (right lower lobe)
Neutropenic typhilitis
Lymphoma
Epiploic appendagitis
Paratubal cysts
Volvulus
Typhlitis

The major differential diagnoses for acute appendiceal abscess or mass include Crohn disease and malignancy.

Differential Diagnoses

Proceed to Workup

Contributor Information and Disclosures

Author

Robert K Minkes, MD, PhD Professor of Surgery, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Medical Director and Chief of Surgical Services, Children's Medical Center of Dallas-Legacy Campus

Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Kirsten A Bechtel, MD Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Deborah F Billmire, MD Associate Professor, Department of Surgery, Indiana University Medical Center

Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Michael Stephen Freitas, MS State University of New York at Buffalo School of Medicine and Biomedical Sciences

Michael Stephen Freitas, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Physical Therapy Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Philip Glick, MD, MBA Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Finance and Development, Department of Surgery, State University of New York at Buffalo

Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons

Disclosure: Nothing to disclose.

Kara E Hennelly, MD Fellow, Department of Pediatric Emergency Medicine, Children's Hospital Boston

Kara E Hennelly, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Michael S Katz, MD Research Fellow, Department of Pediatric Surgery, St Christopher's Hospital for Children

Michael S Katz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Robert Kelly, MD Chairman, Department of Surgery, Departments of Surgery and Pediatrics, Children's Hospital of the King's Daughters; Associate Professor, Eastern Virginia Medical School

Robert Kelly, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Abdominal Surgeons, Medical Society of Virginia, Norfolk Academy of Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Mark V Mazziotti, MD Assistant Professor of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital

Mark V Mazziotti, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey J DuBois, MD Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J DuBois, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and California Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Harsh Grewal, MD, FACS, FAAP Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University School of Medicine

Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jeffrey R Tucker, MD.

References

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Ultrasonographic examination of the right lower quadrant reveals a greater than 6-mm noncompressible tubular structure shown in cross section. Discomfort was noted as the probe was depressed over this structure. A small amount of free fluid is also noted surrounding the appendix.

CT scan depicting a distended tubular structure descending into the pelvis and containing a round calcification (ie, an appendicolith).

CT scan revealing an enhancing tubular structure descending into the pelvis. Periappendiceal inflammation and streaking, so-called dirty fat, is noted surrounding the appendix.

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