Acute appendicitis following blunt abdominal trauma in children: by chance or a cause?

Background: In rare cases, blunt trauma of the abdomen (BTA) can be a direct cause of appendicitis. Purpose: To evaluate whether appendicitis or appendiceal perforation following BTA occurs by chance or cause. Methods: This retrospective study was performed for the period July 2010eDecember 2014. Results: In total, 245 pediatric cases were included. The cause of appendicitis was idiopathic in 190 (77.55%), appendicolith in 30 (12.24%), trivial abdominal trauma in 17 (6.93%), intraoperatively identified hyperplastic lymphoid tissue in six (2.44%), and significant BTA in two (0.81%) children. The symptoms of the two children who developed appendiceal perforation after sustaining BTA began from trauma inception, and BTA was the only apparent etiological factor. The children were a 9-year-old boy who sustained BTA through a bicycle handlebar 4 days previously and an 11-year-old girl who presented at our hospital after falling over a boulder. Both cases were associated with appendicolith, without solid organ injury. Conclusion: Acute appendicitis or appendiceal perforation following significant BTA is rare. In the two corresponding cases in this study, the etiology may have been dislodgement of the appendicolith at the moment of injury. Moreover, children may erroneously implicate appendicular pain to be trivial trauma sustained during play (6.8% of the current cases). In all children presenting with right lower abdominal pain and vomiting following BTA (although trivial), the possibility of appendiceal pathology should be considered. Copyright (C) 2016, Taiwan Surgical Association. Published by Elsevier Taiwan LLC.