Specificity of acute appendicitis in children, geriatric patients & pregnancy.

Question 1

The very young

Answer 1

❖ Rarely < 2y.
❖ Typically symptoms & signs are obscured / absent.
❖ Signs of infection without revealing abdominal origin.
❖ Abdominal X-ray: dilated loops of bowel & fluid levels.
❖ Rapid development of generalized peritonitis due to rudimentary abdominal defense mechanism, in particular the “wrapping” effect of the greater omentum.

Question 2

the elderly

Answer 2

❖ Develops relatively slow.
❖ The Appendix wall becomes fibrotic with age & the area is more readily walled off by omentum & adherent small bowel.
❖ Often resolves spontaneously.
❖ History: often > 1 week of symptoms.
❖ Clinical presentation: obstruction, vomitus, colic pain, obstructed bowel sounds.
❖ A mass may be palpable if patient is relaxed.
❖ X-ray: fluid levels in RLQ.

Question 3

pregnancy

Answer 3

❖ Appendix is displaced upwards.
❖ Laparoscopy indicated but difficult if > 26w.
❖ Mortality up to 9% for mother & 20% for fetus in 3rd trimester.