Pediatric emergency medicine trisk 3747 3747

off the inflamed appendix. As a result, perforation leads to a more disseminated
infection. Although the mortality from appendicitis has decreased over the last
several decades, the incidence of perforation in children has remained the same.
Clinical Assessment
Within a few hours after perforation has occurred, the child begins to develop
increasing signs of peritonitis and toxicity. First, the lower abdomen and then the
entire abdomen become rigid with extreme tenderness. Bowel sounds are sparse
to absent. Other signs include pallor, dyspnea, grunting, significant tachycardia,
and higher fever (39° to 41°C [102.2° to 105.8°F]). Rarely, the patient may
develop septic shock from the overwhelming infection.