Background-The diagnosis of acute appendicitis is often delayed, which may
complicate the further course of the disease.
Aims-To review appendectomy cases in order to determine the incidence of di
agnostic delay, the underlying factors, and impact on the course of the dis
ease.
Methods-Records of all children who underwent appendectomy from 1994 to 199
7 were reviewed. The 129 cases were divided into group A (diagnostic period
within 48 hours) and group B (diagnostic period 48 hours or more).
Results-In the group with diagnostic delay, significantly more children had
first been referred to a paediatrician rather than to a surgeon. In almost
half of the cases in this group initial diagnosis was not appendicitis but
gastroenteritis. The perforation rate in group A was 24%, and in group B,
71%. Children under 5 years of age all presented in the delayed group B and
had a perforation rate of 82%. The delayed group showed a higher number of
postoperative complications and a longer hospitalisation period.
Conclusions-Appendicitis is hard to diagnose when, because of a progressing
disease process, the classical clinical picture is absent. The major facto
r in diagnostic delay is suspected gastroenteritis. Early surgical consulta
tion in a child with deteriorating gastroenteritis is advised. Ultrasonogra
phs can be of major help if abdominal signs and symptoms are non-specific f
or appendicitis.