Modern medicine emphasizes that once acute appendicitis is diagnosed, the appendix should be surgically removed early. Especially in children, appendicitis can change from simple appendicitis to suppurative appendicitis followed by gangrene and perforation of the appendix within a few hours due to the thin appendiceal wall and thin arteries. As the large omentum is shorter in children, it cannot well wrap and confine the inflamed appendix. Once the appendix is perforated, a large amount of pus and intestinal contents in the appendix cavity will flow into the abdominal cavity through the rupture, which will easily spread into diffuse peritonitis and even toxic shock. Therefore, in principle, children with appendicitis are not treated conservatively, and if they hesitate and delay treatment when it is time to operate, serious consequences will result. Parents should be aware of common sense: In fact, the appendix is a remnant of a degenerated tubular organ in the human body; one end is blind and the other end is connected to the large intestine. The appendix of infants and children under five years of age is funnel-shaped with a large base, so the chance of appendicitis is relatively low. After school age, children’s appendixes tend to be tubular in shape and are prone to appendicitis once obstruction occurs. There are many causes of appendiceal obstruction in children. The most common ones are when inflammation occurs in the respiratory or gastrointestinal tracts, the lymphatic follicles in the appendiceal wall become enlarged and obstruct the appendiceal cavity; or feces and appendiceal mucosal secretions are retained in the appendiceal cavity and the water is absorbed to form fecal stones causing obstruction; individually, the appendiceal cavity may also be obstructed by foreign objects such as fruit kernels, small beans or parasites such as roundworms. Once the appendiceal cavity is obstructed, secretions are retained in the cavity, causing inflammation and swelling of the appendix. Since children have more delicate tissues and their appendiceal arteries are thinner, once inflammation and swelling occur, it is easy to cause appendiceal wall bruising and ischemia which is more likely to cause appendiceal necrosis and perforation than adults. It is these anatomical features and influencing factors that make appendicitis in children the most common pediatric emergency abdomen, accounting for about 2/3 of pediatric surgical emergencies. II. Important basis for physician diagnosis Appendicitis in children is mainly manifested by three major symptoms: abdominal pain, vomiting and fever, but the specific manifestations vary from child to child. The abdominal pain is the first to appear. Infants and toddlers, who are not good at expressing themselves, will only keep crying and scratching throughout the abdomen. In older children, the pain starts around the belly button and gradually becomes fixed in the right lower abdomen. Since appendicitis is mostly associated with obstruction of the appendiceal cavity, this abdominal pain tends to be more and more intense in bursts. Most children have vomiting and nausea because the nerves to the appendix come from the sympathetic nerves in the mesenteric roots, and when the appendix becomes inflamed, they irritate the nerves causing gastrointestinal symptoms, so they are sometimes misdiagnosed as gastroenteritis or intestinal cramps. Appendicitis in children is often not febrile in the early stages, but only when the inflammation is more pronounced with a fever of about 38°C. However, when the appendix is perforated causing peritonitis, a high fever of 39°C or more can occur. It is true that there is no very authoritative or certain diagnostic aid for acute appendicitis, but the surgeon’s physical examination, or “feel the belly” as they say, is very informative. The pressure point of acute appendicitis is often very fixed, mostly located in the right lower abdomen at the “Mac’s point”. Although infants are not very cooperative and can’t describe it correctly, the child’s painful expression when the doctor touches this pressure point, and especially the child’s crying and moaning when the doctor’s hand is pressed deep into the abdomen and lifted up quickly, are very important grounds for diagnosing appendicitis. Of course, elevated white blood cells in routine blood tests, ultrasound examination in chronic appendicitis or appendiceal masses, and anal examination are also helpful in the diagnosis of some specific appendicitis. The most important thing is that you should not hesitate to operate. Modern medicine emphasizes that once acute appendicitis is diagnosed, the appendix should be surgically removed early. Especially in children, appendicitis can change from simple appendicitis to septic appendicitis followed by gangrene, leading to appendiceal perforation, due to the thin appendix wall and thin arteries, living in a dozen or even a few hours. Since the large omentum is shorter in children, it cannot well wrap and confine the inflamed appendix. Once the appendix is perforated, a large amount of pus and intestinal contents in the appendix cavity will flow into the abdominal cavity through the rupture, and it is very easy to spread into diffuse peritonitis and even toxic shock. Therefore, in principle, appendicitis in children is not treated conservatively, and if there is hesitation and delay in treatment when it is time to operate, serious consequences will result. Fourth, complications are not sensational In fact, it is entirely possible for complications to occur after appendiceal surgery. If you include mild complications such as incisional infection and postoperative respiratory infection the incidence of complications after appendectomy is 3% to 5%. The most common of these are incisional infection, pelvic or subphrenic abscess, adhesive bowel obstruction,, bleeding, fecal fistula, and appendiceal stump infection. Incisional infections are those that occur at the incision site during the removal of an infected and septic homocyst. Pelvic or subdiaphragmatic abscesses occur because of purulent appendicitis, especially perforated appendicitis, whose pus enters the abdominal cavity; after appendectomy, most of the pus is absorbed by the peritoneum under the action of antibiotic therapy and its own resistance, but there are individual cases when pus collects and becomes an abscess, which is most likely to form in the lowest part of the abdominal cavity in the horizontal position – -The abscess is most likely to form in the pelvic cavity or under the diaphragm. Adhesive intestinal obstruction, on the other hand, is due to the fact that the originally smooth peritoneum and organ plasma membrane become gross after appendectomy, and the fibrin-like material formed by the absorption of pus and perforated pus, which makes it very easy to form intestinal adhesions and even intestinal obstruction after surgery. In addition, respiratory infections, gastroenteritis, measles, etc. can be complicated after surgery due to the decreased resistance of children after surgery and cross-infection between other children and their families in the hospital. In order to prevent these postoperative complications, parents should cooperate with doctors and encourage their children to get up and move around early after surgery to reduce the occurrence of abscesses and intestinal adhesions. In addition, the child’s own cleanliness and hygiene should be actively done to reduce the chance of cross-infection of bacteria and viruses.