I. Overview Acute appendicitis is the most common disease in pediatric emergency abdomen, which was first named by Fitz, a professor of pathology at Harvard University in 1886, with the greatest contribution from Charles McBurney of the Columbia College of Surgeons in New York, who reported a group of cases of appendicitis treated surgically in the New York Journal of Medicine in 1889 and described in detail the He reported a group of surgically treated cases of appendicitis in the New York Journal of Medicine in 1889 and described in detail the features of metastatic abdominal pain and the projection of the appendix on the abdominal surface (the famous “McBurney’s point” later named after him), and first proposed a surgical treatment plan for this disease. The cause of pediatric acute appendicitis is still not clear, but it is thought to be a combination of the appendix itself, peristaltic dysfunction of the intestinal nervous system and obstructed blood circulation. Therefore, it is necessary to pay attention to the following points: 1. Pediatric cold, diarrhea, gastrointestinal flu, etc. may cause peristaltic dysfunction of the gastrointestinal tract, which should be alerted when it is complicated by abdominal pain; 2. Pediatric upper respiratory tract infection, tonsillitis, etc. make germs invade the blood circulation, stimulate reactive hypertrophy of the appendix wall, and cause obstruction of blood flow, which may also become the cause of appendicitis; 3. Most importantly, the appendix cavity is blocked by fecal stones, foreign bodies or parasites Blockage of the appendix cavity by fecal stones, foreign bodies or parasites, poor drainage of the appendix cavity contents and bacterial multiplication are the main causes of acute appendicitis; moreover, prolonged blockage of the appendix cavity may cause impaired blood circulation in the appendix itself, which may further lead to tissue ischemia, resulting in serious conditions such as necrosis and perforation of the appendix. III. Diagnosis The early diagnosis of pediatric appendicitis is not very simple, so one needs to pay attention to every detail of the child, especially the need to be alert to possible situations and be able to have this string in the consciousness! After all, it is the parent who is closest to the child and has the most contact with him/her, not the doctor who is expected to make a diagnosis with just a few minutes of contact. Abdominal pain is the most common symptom of pediatric appendicitis, but it is also the most indeterminate. Younger children are unable to express their pain exactly and may be more likely to be crying, upset or, in severe cases, depressed, while older children may be able to express the concept of “abdominal pain” but may not be able to describe the sensation in detail. Therefore, parents need to pay attention to any manifestation of “abdominal pain”: first, the time of the abdominal pain, whether it is accompanied by other diseases, such as the presence of colds, fever, diarrhea, vomiting after the abdominal pain, should be enough attention; second, the change of abdominal pain, should be carefully observed, abdominal pain changes. In any case, comparing the aggravation or reduction of abdominal pain is an important element to determine whether you should take your child to the doctor; also, it is the expression of the child during abdominal pain, especially the mental state. Generally speaking, most of the pains of surgical diseases are more rapid in onset, fast in development and more intense, and the child may appear in a passive position, such as curled up in a ball, afraid to straighten the waist, unable to walk, etc. The rest of the symptoms are atypical, such as fever, vomiting, or even diarrhea. As for the diagnosis and treatment of pediatric appendicitis, on a side note, most people think that this should be a matter for the doctor, and most parents think that if they go to the hospital, everything will be fine and they will leave their child with the doctor and listen to him or her. I often hear parents say to me in the clinic, “Doctor, I’m leaving my child in your hands, please take care of it!” I am actually apprehensive, because treatment is a matter between the doctor and the patient, and even though the parents are not doctors and cannot know everything, they cannot say, “I leave my child with you and it’s OK, just take care of it. More often than not, I respond to parents like this: “It’s not about me, it’s about us working together!” The diagnosis of appendicitis needs to be supported by evidence from several sources: first, the medical history, which requires the parents who are in close contact with the child to provide as much detailed information as possible, that is, the time of occurrence of the abdominal pain mentioned above, complications, changes, etc.; second, the physical examination, where the doctor focuses on the pressure pain in the right lower abdomen, emphasizing the abdominal pain and the fixity of the pressure pain, that is, the right lower abdomen; and finally, the corresponding auxiliary tests, such as Blood routine, urine routine, abdominal ultrasonography, and even abdominal CT, etc. Of course, these are all hard indicators, and the final clinical diagnosis still needs to be based on the doctor’s clinical experience to comprehensive analysis. Even with the rapid development of technology today, a thorough history and careful physical examination still play an important role in the diagnosis of appendicitis, and one should not put the cart before the horse and rely too much on other ancillary tests. This is especially important in pediatric patients. As early as the 1960s, a number of authors have calculated the diagnosis of patients hospitalized with abdominal pain for less than a week, and many children with abdominal pain resembling acute appendicitis, some of them even ready for surgery, but during this period 1/3 of the children’s signs and symptoms suddenly disappeared. “The follow-up data at 0.5-2 years after discharge in 325 cases suggested that only 18 cases required readmission, 6 with acute appendicitis and 3 with non-appendicitis diseases such as intussusception. the existence of acute non-specific abdominal pain was also confirmed in a network chase study by Oxford et al (1970). Pediatric patients should also be differentiated from pneumonia or pleurisy, acute mesenteric lymphadenitis acute gastroenteritis, intestinal ascariasis, and allergic purpura, so the diagnosis of appendicitis should also pay attention to its differential diagnosis. It is not advocated here that the correct diagnosis should not be made actively and quickly, but rather that a short period of active observation should be allowed for suspicious cases, that is, constant comparison of symptoms, signs and laboratory test data. We ask that the rate of negative surgery and perforation be minimized. It is wrong to put too much emphasis on surgery only after the diagnosis is confirmed or to put too much emphasis on early surgery without regard to the correctness of the diagnosis. It is difficult to reduce both the rate of appendiceal perforation and the rate of negative surgery, and since the appendix in pediatric patients is high, relatively free and mobile, the site of pressure pain is highly variable, therefore, in many primary care hospitals, which are still based on metastatic right lower abdominal pain and fixed right lower abdominal pressure pain points as the main diagnostic tools, it is required to accurately grasp the timing of surgery on the one hand, and allow a period of active observation on the other. By active observation is meant the measures taken in cases with atypical history and signs, where the child is temporarily kept without food or drink, given fluids, without painkillers, and observed by the same physician every 1-2 hours for changes in symptoms and signs, and for routine blood and urine review, even including C-reactive protein determination. The following three outcomes are generally observed: (1) In many children, the abdominal pain is diagnosed to be due to medical illness, such as upper sensation, urinary tract infection, constipation, and diabetic ketoacidosis. Treatment was given accordingly. (2) A few showed aggravation of the intra-abdominal lesion and required immediate surgical exploration. (3) In the remaining cases, the diagnosis of acute nonspecific abdominal pain can be considered if the signs gradually improve, otherwise, surgery should be actively prepared. The gold standard for the treatment of appendicitis is still followed in the textbooks of higher medical schools prepared by the Ministry of Health: “Once diagnosed, operate as soon as possible”. When appendicitis was first discovered and named, the true cause of appendicitis was not clear until 1889, when Charles McBurney reported in detail a group of cases of appendicitis treated surgically, and surgery became known as an effective treatment for this type of disease; in 1900, Riddell and others claimed that In 1900, Riddell and others claimed that perforated appendicitis had little hope of survival without surgical treatment, so surgical treatment options were adopted, when the London Hospital reported in 1905 that the overall mortality rate of acute appendicitis was 26%, but once acute peritonitis occurred its mortality rate could be as high as 76%. For this reason, surgeons treated cases of appendicitis with an unknown or suspicious diagnosis with an attitude of rushing to early surgical exploration, and another bias was created, namely an increase in the rate of negative exploration. Until the end of the 20th century, the diagnosis of acute appendicitis continued to be challenged by the removal of a normal appendix, the so-called negative resection rate of 9%-40%, a rate roughly the same as in the early days. The rate of appendiceal perforation was 11%-32%, and despite the recent development of ultrasound and CT scans and laparoscopy, the rate of perforation and negative resection of appendicitis remained unchanged despite delays in diagnosis and treatment.Hale et al. analyzed data from 4950 appendectomies and found that the rate of appendiceal perforation was 25% and 22% in male and female patients, respectively, and the rate of appendiceal perforation was 48% in patients younger than 8 years of age, and the rate of negative appendectomy was 13.2% and under 5 years of age was 22%. A multifactorial analysis showed that despite the rapid advances in medical technology in recent years, appendiceal perforation and negative resection rates have not decreased significantly, due to the lack of effective objective diagnostic methods. The greatest risk of appendicitis comes from the crisis of perforation. I often hear many doctors say that appendicitis is treated conservatively for only three days, starting with abdominal pain, and after three days it may become perforated and necrotic, which may cause increased mortality or inoperable, etc. Therefore, doctors pay attention to the negative consequences of “perforation”. Therefore, actively preventing the incidence of perforation is another new topic. There are two main causes of appendiceal perforation: delay of the patient before hospitalization and delay of the physician after hospitalization, and the former is the main cause, which requires parents to have this string – pay close attention to the changes in abdominal pain! Delays by physicians after hospitalization can be mostly avoided if they are actively observed. In summary, although pediatric acute appendicitis is a simple disease, its diagnosis and treatment are still not easy, especially when diagnosed early. In teaching hospitals, the Department of Surgery classifies this disease as an object of enlightenment teaching, so that among some young physicians it is commonly considered as a simple disease to deal with, without careful analysis of the medical history, as long as the right lower abdominal pain is encountered, it is judged as acute appendicitis, Biomqvst (11) statistics in recent years 117424 cases of appendectomy mortality rate, ≤9 years old is 0.31‰, Zhang Jinzhe statistics in China 9506 cases of appendectomy The mortality rate of appendectomy was 0.65‰ for ≤5 years old (7). This is closely related to the untimely diagnosis and appendiceal perforation. Suspicious cases can be actively observed for a short period of time, as the symptoms can be temporarily relieved in 1/3 cases, but again, attention should be paid to the timely timing of surgical exploration.