What are some of the pitfalls in diagnosing appendicitis?
The presentation of a child with appendicitis may not be “textbook.” The absence of fever or anorexia, pain in an atypical location, the presence of diarrhea, prolonged symptoms, and normal laboratory values can occur in patients with appendicitis.
An appendix that is located in the lateral gutter can cause flank pain and lateral abdominal tenderness; an appendix that lies toward the left may produce hypogastric tenderness; and a retrocecal appendix may cause back or pelvic pain or pain elicited only on deep palpation.
Although vomiting occurs more commonly, diarrhea may result from direct sigmoid irritation from the adjacent low-lying pelvic appendix. Similarly, bladder or ureteral irritation may result in dysuria and pyuria, confusing the diagnosis for a urine infection.