Appendicitis and surgical abdomen — branching viva

Opening — framing the problem

The examiner begins: a previously well nine-year-old has eighteen hours of peri-umbilical pain that has moved to the right iliac fossa, with anorexia, nausea and a temperature of 38.4 degrees, and is tender at McBurney point with a wince on hopping. Talk me through your approach. ^[1]

I would frame this as acute appendicitis, the commonest abdominal surgical emergency of childhood, and recognise the migratory pain with anorexia and localised tenderness as itself the key clue. My priorities would be to assess and resuscitate, to score with the Pediatric Appendicitis Score, to confirm with ultrasound first, and to involve the paediatric surgeon early, because timely appendicectomy prevents perforation and a missed surgical abdomen costs bowel. ^{[1] [3]}