Diagnosing pediatric appendicitis

Appendicitis is the most common surgical cause of abdominal pain in children. The diagnosis is fairly straightrorward in a child with the classic history of epigastric or periumbilical pain followed by anorexia, nausea, or vomiting, with migration of pain to the right lower quadrant of the abdomen and low-grade fever. It is the child with an equivocal history or physical examination that provides the diagnostic challenge. The additions of ultrasonography and computed tomography to the radiologic evaluation has improved the clinician's ability to diagnose appendicitis, but the diagnosis is not always made.