Department of Surgery/ Kirkuk General Hospital/ Kirkuk/ Iraq


Objectives: This study was planned to show the mode of presentation of children under six years of age with acute appendicitis and to increase the awareness of general, pediatric surgeons and other health care professionals about the magnitude of the problem so that to improve diagnostic accuracy and to avoid detrimental effects of delay in diagnosis and effective surgical management. Patients and Methods: The study included (67) children with clinical suspicion of acute appendicitis admitted to emergency department of Kirkuk General Hospital from January 2008 - June 2012. Their age ranged (3 – 6) years (Mean age 4.5 years). (39) Males and (28) females. (M: F was 1.4:1). All had appendectomy as an emergency setting. The presentation, diagnostic work up and operative findings were studied. Results: The main presenting symptom was abdominal pain 62(92%) followed by vomiting which was seen in 53(77%) of our patients. Other symptoms were change in bowel motions, anorexia, abdominal distension and fever. The most common physical sign elicited was localized tenderness at right lower quadrant 64(95%) while guarding was present in nearly half of our patients 36(53%). (41) Children had urgent appendectomy as diagnosis of acute appendicitis was clear and in the remainder (26) children a period of active observation and serial examinations with completion of diagnostic work up were needed before surgical intervention. Conclusion: Acute Appendicitis in preschool children under six years of age needs special consideration. About one third of them have atypical presentation, physical signs are difficult to be elicited. A period of active observation in needed in most of them to complete diagnostic work up. Every effort should be directed towards improving the diagnostic accuracy and performance of effective surgical management to reduce morbidity and mortality and to decrease negative appendectomy rate and to avoid risks of unnecessary surgery