Appendiceal Colic in Children: Is It a True Surgical Entity?

Background/Purpose: For decades children have been crowding the offices of Pediatricians’ and Pediatric Surgeons with a common complaint of unexplained recurrent right lower quadrant pain. For years the topic of appendiceal colic as a cause for this recurrent abdominal pain has remain controversial. This paper highlights the experience of a single surgeon over a 5-year period using an algorithmic approach to diagnose and treat children with appendiceal colic. Methods: This is a retrospective review of 31 consecutive cases of patients experiencing recurrent unexplained right lower quadrant abdominal pain for greater than three weeks. All patients were evaluated by a single surgeon at the same institution. The patients meeting the criteria for appendiceal colic had an elective open appendectomy. The data included was compiled by a retrospective chart review from Jan. 1, 2006 to Dec. 31, 2010. Results: Twelve percent or 31 of the 238 elective appendectomies done between Jan. 2006 to Dec. 2010 where done for appendiceal colic. Sixteen were females and 15 where males ranging in age from 5 17 years of age. Average duration of symptoms was 3 weeks to 5 years. All patients had previous work up most of which where inconclusive for an organic cause. All patients presented with colic and McBurney’s point tenderness. On pathological examination the presence of a fecalith, inspissated stool or fibrosis were the most common findings. A normal appendix was observed in 14% of the cases. 100% of the patients were symptom free with three months of operation. Conclusion: Appendiceal colic proves to be true in a small subset of patients presenting with unexplained right lower quadrant abdominal pain. A high index of suspicion coupled with a thorough history and physical exam is needed to identify these patients. Classically they will present with recurrent right lower abdominal pain at McBurney’s. In our experience an elective appendectomy has been curative.