Kaohsiung Journal of Medical Sciences
Volume 25, Issue 1 , Pages 1-9, January 2009

Children Presenting at the Emergency Department With Right Lower Quadrant Pain

  • Chien-Heng Lin

      Affiliations

    • Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
    • Central Taiwan University of Science and Technology, Taichung, Taiwan
    • ,
  • Jeon-Hor Chen

      Affiliations

    • Department of Radiology, China Medical University Hospital, Taichung, Taiwan
    • ,
  • Tsai-Chung Li

      Affiliations

    • Biostatistics Center, China Medical University, Taichung, Taiwan
    • ,
  • Yung-Jen Ho

      Affiliations

    • Department of Radiology, China Medical University Hospital, Taichung, Taiwan
    • ,
  • Wei-Ching Lin

      Affiliations

    • Department of Radiology, China Medical University Hospital, Taichung, Taiwan
    • Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Wei-Ching Lin, Department of Radiology, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan

Received 30 January 2008; accepted 22 December 2008.

Article Outline

Right lower quadrant (RLQ) pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of patients. We also investigated if active observation resulted in delayed diagnosis, to the detriment of patients. Medical records for the period January 2006 to July 2006 were reviewed for children (age < 18 years) who presented to the emergency department of one medical center, complaining of RLQ pain. Out of a total of 100 patients (age range: 2–17 years; mean: 11 years), 46 patients presented with only one symptom of RLQ pain, while 32 patients had ≥ 2 associated signs or symptoms, including fever, nausea/vomiting, diarrhea, or rebound tenderness. Imaging studies, including abdominal sonography and/or computed tomography, were performed in 73 patients; 44 underwent surgery for presumed appendicitis and one received surgery for a right paraduodenal hernia. Eleven patients underwent surgery because of peritoneal signs, and eight because of persistent or aggravated RLQ pain. Postoperative pathologic examinations revealed 53 cases of appendicitis, six normal appendices, and other morbidities (1 perforated peptic ulcer, 1 pelvic inflammatory disease, 1 ovarian cyst, 1 diverticulitis, and 1 right paraduodenal hernia). Thirty-three patients were discharged after several hours of observation (range: 0.5–18 hours; mean: 4 hours), and three patients were admitted for further observations. All were discharged without operation. There were significant differences in the incidences of fever (p = 0.004) and rebound tenderness (p = 0.019), and in white cell counts (p < 0.001), neutrophil percentages (p < 0.001), and C-reactive protein levels (p < 0.001) between patients with appendicitis and patients with other causes of RLQ pain. Clinical signs and symptoms, laboratory tests, and imaging studies can be used to differentiate between the causes of RLQ pain. Patients without the classical features of appendicitis or peritonitis can be safely managed by active observation and repeated physical examinations.

Key Words:  children , emergency department , right lower quadrant pain

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PII: S1607-551X(09)70033-6

doi:10.1016/S1607-551X(09)70033-6

Kaohsiung Journal of Medical Sciences
Volume 25, Issue 1 , Pages 1-9, January 2009

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