Children
- Acute appendicitis is rare in children but they are most likely to present with perforation
- In children, the underdeveloped omentum cannot contain the rupture – localisation is not present
- Therefore peritonitis occurs early
- Clinical features are similar to adult disease
- Right lower quadrant tenderness
- Pain on percusson/coughing
- Child is unable to walk
- Neonates can also present with lethargy or irritability
- Differential diagnosis is espeically important in the paediatric population
- Intussusception – red currant jelly stools, abdominal mass
- Ovarian or testicular torsion
- Meckel’s diverticulitis
- Gastroenteritis – no leukocytosis
Older adults
- Can have an atypical presentation – lower abdominal pain is not localised to right lower quadrant
- Patients can present with fullness of the abdomen
- Gangrene and perforation occur more frequently than in younger adults
- Because of the lax abdominal wall, localisation is poor and peritonitis occurs early
- Co-morbidities can increase the risk of complications
- Differential diagnoses
- Carcinoma caecum
- Intestinal obstruction
- Mesenteric ischemia
- Crohn’s disease
In pregnancy
- Most common in the 2nd and 3rd trimester
- Majority of clinical features are similar to usual appendicitis
- Atypical features
- Appendix shifts to upper abdomen, so pain is higher and more lateral – especially in the 3rd trimester
- Heartburn, bowel irregularity, flatulence, change in bowel habits
- A pelvic appendix can cause tenderness below McBurney’s point – leading to urinary or rectal symptoms
- Frequency, dysuria, tenesmus, diarrhoea
- Rebound tenderness and guarding may not be evident
- Appendix perforation increases the risk of fetal death
- Laparoscopic appendectomy is preferred