Atypical Clinical Presentation and Late Diagnosis: A Retrospective Study of Uncomplicated and Complicated Appendicitis in Paediatric Age Groups

Abstract

Introduction: Children tend to have a higher rate of appendicular perforation compared to adults. In small children and the elderly, the diagnostic accuracy is low, and the perforation rate is high. Children with appendicitis are brought late to the hospital compared to adults, leading to delays in the diagnosis and treatment, thereby increasing the risk of complicated appendicitis. Objective: The objective of this study was to delineate the atypical presentations of appendicitis across the different paediatric age groups treated in a tertiary care center and to compare the disease course and outcomes of complicated appendicitis in atypical and typical presentations. Study Design: This was a retrospective study of 273 children who developed appendicitis and underwent treatment for the same in a tertiary hospital between June 2011 and May 2019. Results: Children who presented with loose stools and dysuria in addition to abdominal pain, fever and vomiting were grouped under the atypical category. The appendix was perforated more in the atypical group (67.6%) compared to the typical group (29.2%) found during surgery (P < 0.001). Similarly, the atypical group had a higher number of mass (37.8%) (P < 0.001) and abscess formation (40.5%) (P = 0.004) compared to the typical group. Children with atypical presentation in the age group of <6 years (87.5% as against 39.3%; P = 0.041) and 6–11 years (68.2% as against 31.6%, P = 0.002) when compared to older paediatric age group had significantly more complications. Conclusion: Diagnosis of appendicitis in preschoolers and young children is a difficult task due to uncommon or atypical presentations. Misdiagnosis or delay in diagnosis and treatment in atypical cases of appendicitis in children have an increased risk of presenting with complications.