Minerva Pediatrica 2018 Jul 18

DOI: 10.23736/S0026-4946.18.04968-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Complicated appendicitis wrongly diagnosed as nonspecific diarrhea: ways to decrease this continuous threat

Baruch KLIN ¹ ✉, Leonid ZLOTCAVITCH ², Oleg LYSYY ³, Yigal EFRATI ¹, Ibrahim ABU-KISHK ⁴

¹ Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; ² University of Miami, Miami, FL, USA; ³ Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; ⁴ Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

BACKGROUND: The diagnostic assessment of right lower quadrant pain in children and adolescents is still a challenge. The aim of this study was to analyze the cases of complicated appendicitis wrongly diagnosed as nonspecific diarrhea, and based on the information obtained suggest a clear and simple policy in order to decrease misdiagnosis in the future.
METHODS: Three groups of patients were analyzed: children who underwent appendectomy (group 1); those with gastroenteritis (group 2), and those who underwent appendectomy following hospitalization under the wrong diagnosis of gastroenteritis (group 3).
RESULTS: Group 3 presented a more prolonged and complicated clinical course, higher fever, diffuse abdominal pain, repeat vomiting, higher C-reactive protein values, longer surgery duration and recovery.
CONCLUSIONS: When the etiology of right lower quadrant abdominal pain is not immediately evident and associated with atypical diarrhea, high fever, repeat vomiting, and significantly increased CRP values, early surgical consultation is required. If the clinical findings are unclear, an abdominal US should be performed as soon as possible. A limited abdominal computed tomography scan CT should follow those cases not resolved by history, physical examination, blood tests, and abdominal ultrasound.

KEY WORDS: Acute gastroenteritis - Acute appendicitis - Diarrhea - Abdominal pain - Ultrasound - Abdominal CT scan