Chronic right-lower-quadrant abdominal pain: is there a role for elective appendectomy?

Abstract

Background/purpose: Chronic right-lower-quadrant abdominal pain is a frequent problem in the pediatric population. The purpose of this report is to detail the outcome of management of these patients with appendectomy.

Methods: Appendiceal colic was judged to be present if the history showed cramping abdominal pain in association with McBurney's point tenderness. This is a retrospective review of 50 consecutive pediatric patients experiencing pain for greater than 1 year. All patients were evaluated at a single institution by one surgeon and underwent elective appendectomies from April 1985 through April 1997.

Results: Seventy-five percent of the patients were girls. One hundred forty-nine imaging and endoscopic studies were performed with 135 negative findings. Twenty-three patients had a minimum of one previous emergency room visit or hospitalization for the same abdominal complaints. The pathological findings were distinctly different from those of incidental appendectomies. Three patients had undergone previous diagnostic explorations for abdominal pain, the appendix was not removed, and a subsequent appendectomy relieved the discomfort. Forty-nine of the 50 patients were pain free at 1 year.

Conclusions: Appendiceal colic is a clinical diagnosis. It is anticipated that patients with cramping abdominal pain associated with McBurney's point tenderness could undergo less preoperative workup and expedited resolution of the problem in the future.