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Appendicitis: Children
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Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis in his or her lifetime. The incidence is highest among males aged 10 to 14, and among females aged 15 to 19. More males than females develop appendicitis between puberty and age 25. It is rare in infants and children under the age of two. In the United States, appendicitis occurs in four out of 1,000 children.
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Appendicitis is more common in boys than in girls, and can run in some families. It is ... more common with certain medical conditions, such as cystic fibrosis. Some have also suggested that it may be more common in children with a diet low in fiber.
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In children less than 3 years of age, viral illnesses and ileocolic intussusception (where the last part of the small intestine moves up into the large intestine) are two of the more common conditions which can be confused with appendicitis. In children in whom the immune system is decreased (often patients with leukemia) the right colon may get sick and swollen as a result of bacteria invading the intestinal wall (typhlitis) and may be the cause of severe right lower abdominal pain which may be difficult to distinguish from appendicitis. The CT scan in patients with typhlitis may demonstrate thickening of the right side of the large intestine.
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The literature suggests that limited helical CT with rectal contrast enhancement is a highly accurate, time-efficient, cost-effective way to evaluate adults with equivocal presentations for appendicitis. Two studies of focused helical CT with rectal contrast in children suggest a sensitivity of 95-97%. This is an excellent diagnostic approach in patients with equivocal presentations who are poor candidates for intravenous contrast.
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About one in five children who have an operation for appendicitis turn out to have another cause for their pain. This has to be balanced against the risk of the appendix rupturing if the operation is unduly delayed. The surgical team will discuss the factors in the decision to operate in detail with you.
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Although medical data is sparse, some research has found that a high-fiber diet may help prevent appendicitis in children. Children who eat a low-fiber diet high in refined carbohydrates are at greater risk for appendicitis, possibly because of the increased risk of obstruction at the appendix, according to the July 2001 issue of the Annals of Emergency Medicine.
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