Acute appendicitis in a child with nonspecific signs and symptoms and nondiagnostic sonography: Necessity of computed tomography

Acute appendicitis is a common acute abdomen in children, especially in children over 5 years old. Although the incidence rate is lower than that of adults, the disease is more serious than adults. The rate of complication of peritonitis and perforation of appendix is even high. Generally, abdominal pain is still the main symptom of acute appendicitis in children, but children cannot express it, parents and doctors are easy to neglect. Ultrasound is the most commonly used imaging examination in the diagnosis of acute appendicitis in children. High fever can appear earlier, up to 39°C, at the same time can have mental atrophy, chills, convulsions and toxic shock. However, when the clinical symptoms of patients are not typical, and no obvious abnormality is found by ultrasound, it is easy to cause misdiagnosis to clinicians. Here we report a case of 9-years-old Chinese female with intermittent abdominal pain and vomiting. Initially she was diagnosed with acute gastroenteritis and was treated with antibiotics. However, there was nothing found by ultrasound, and her abdominal pain symptoms still did not relieve. Finally, abdominal CT examination confirmed acute appendicitis after 48 hours. The lesson is that ultrasound scanning should not be limited to the right lower abdomen, due to the great variation of appendix position in children with appendicitis. In addition, if there is no abnormality found by ultrasound and the infection index is increased, we suggest that abdominal CT should be examined immediately.