Title:A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit
Volume: 21
Issue: 1
Author(s): Kam L. Hon*, Alexander K.C. Leung, Yan T.K. Lee, Stephanie Tsang, Karen K.Y. Leung, Wun F.A. Hui, Wing L. Cheung and Wai Y.M. Leung
Affiliation:
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong, China
Keywords:
Critical care, appendicitis, rupture, peritonitis, pancreatitis, pseudo-appendicitis.
Abstract:
Introduction: Appendicitis is a common childhood condition that can be diagnostically
challenging. Severe cases may necessitate support in the critical or intensive care unit. These “critical
appendicitis diagnoses” have rarely been described.
Case Description: We retrospectively reviewed the Paediatric Intensive Care Unit (PICU) database
of the Hong Kong Children’s Hospital and identified cases of suspected and confirmed appendicitis.
Clinical features, radiologic findings and final diagnosis of each case were summarized and reported
in this case series. We review six anonymized cases of appendicitis managed in a PICU to illustrate
the different age spectrum and clinical manifestations of the condition. Rupture of the inflamed
appendix, peritonitis and pancreatitis were some of the complications encountered. Crohn’s disease
was found in one case as an underlying diagnosis. Also, one girl clinically diagnosed with appendicitis
was found to be a case of ruptured hepatoblastoma with no appendicitis (i.e., pseudoappendicitis).
Conclusion: Prompt diagnosis, surgical removal of the inflamed appendix, and use of appropriate
antimicrobials when indicated are essential in reducing mortality and morbidity associated with severe
appendicitis. Significant premorbid conditions such as acute myeloid leukemia, Mitochondrial
Encephalopathy Lactic Acidosis Syndrome (MELAS), inflammatory bowel disease and complications
may be present in patients needing intensive care as is illustrated in the present cases. Pseudoappendicitis
is an important differential diagnosis. Imaging is crucial and useful in establishing and
confirming the diagnosis of appendicitis and pseudo-appendicitis in these PICU cases.
