CASE REPORT article
Front. Pediatr.
Sec. General Pediatrics and Pediatric Emergency Care
Diagnostic Challenges in Pediatric Appendicitis: A Case of Perforated Appendicitis with Secondary Hepatic Abscess
Provisionally accepted
- 1Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 2Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- 3Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Appendicitis in young children (age <5 years) frequently presents with atypical symptoms, creating diagnostic challenges in primary care and emergency settings. This report describes a 4-year-old girl who presented to the emergency department with fever, vomiting, and abdominal pain. Initial evaluation including abdominal ultrasound showed no evidence of appendicitis, and she was discharged with a presumptive diagnosis of viral gastroenteritis. Five days later, she was readmitted with persistent symptoms and markedly elevated inflammatory markers. Advanced imaging revealed a hepatic abscess, initially attributed to primary liver pathology. Diagnostic laparoscopy ultimately revealed perforated appendicitis with secondary hepatic abscess. The patient underwent successful laparoscopic appendectomy and abscess drainage with complete recovery. This case highlights the essential clinical approach of maintaining a broad differential diagnosis, recognizing the limitations of imaging, and mandating systematic re-evaluation with structured follow-up when a patient's expected clinical improvement fails to materialize.
Keywords: Abdominal Pain, acute appendicitis, case report, Hepatic abscess, pediatric
Received: 09 Jan 2026; Accepted: 02 Feb 2026.
Copyright: © 2026 Li, Lin, Yu, Zhang and Duan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yilian Duan
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