Acute appendicitis is the most common indication for emergency laparotomy in children.
The pathogenesis generally begins with luminal obstruction. Continued natural secretions of mucus within the appendix leads to distention. Luminal bacteria multiply as venous engorgement develops secondary to the elevated intraluminal pressure causing vascular compromise. Finally, arterial compromise ensues and perforation occurs with the development of a periappendiceal abscess. The usual initial symptoms are vague visceral abdominal pain secondary to the distention of the appendix.