When appendicitis is suspected in children

Acute appendicitis is the most common condition requiring emergent abdomina l surgery in childhood. The clinical diagnosis of acute appendicitis is oft en not straightforward because approximately one-third of children with the condition have atypical clinical findings. The delayed diagnosis of this c ondition has serious consequences, including appendiceal perforation, absce ss formation, peritonitis, sepsis, bowel obstruction and death. Cross-secti onal imaging with ultrasonography (US) and computed tomography (CT) have pr oved useful for the evaluation of suspected acute appendicitis. There has b een a great deal of variability in the utilization of these modalities for such diagnosis in the pediatric population. The principal advantages of US are its lower cost, lack of ionizing radiation, and ability to assess vascu larity through color Doppler techniques and to provide dynamic information through graded compression. The principal. advantages of CT include less op erator dependency than US, as reflected by a higher diagnostic accuracy, an d enhanced delineation of disease extent in a perforated appendix.