Diagnostic accuracy of pediatric atypical appendicitis

RATIONALE: Acute appendicitis is one of the most common causes of acute abdomen in children, yet it is difficult to diagnose in young children because its clinical manifestations may be atypical. Here, 3 atypical clinical cases associated with appendicitis in children are reported. PATIENT CONCERN: The 1st case corresponds to a 5-year-old male patient who presented with abdominal discomfort, intermittent fevers, and vomiting, have increased white blood cell (WBC) count and C-reactive protein (CRP). The second case is a 7-year-old male patient who began with intermittent fevers and lower quadrant abdominal pain, showing increased WBC count and CRP. The 3rd case corresponds to a 7-year-old female patient who presented with intermittent fevers, abdominal pain, and forebreast discomfort, demonstrating increased WBC count and CRP. DIAGNOSES: Abdominal computed tomography (CT) scan presented data suggestive of enlarged appendix in diameter, and stercolith, corroborated through surgery. INTERVENTION: Two patients were treated by appendectomy, and 1 patient was treated conservatively with antibiotics. OUTCOMES: Three patients were treated successfully. At 3-month follow-up, the patients had no complaints of discomfort with no relapse of appendicitis. LESSONS: Due to atypical symptoms of children, the diagnosis of appendicitis is often delayed, suggesting that the clinicians should be aware of this disease when encountering gastroenteritis patients with elevated WBC and CRP. Furthermore, abdominal CT scan should be taken into consideration when patients showed high level of WBC and CRP, whose appendix is not seen on ultrasound.