{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T07:09:39Z","timestamp":1771571379837,"version":"3.50.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Appendicitis in young children (age &amp;lt;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.<\/jats:p>","DOI":"10.3389\/fped.2026.1784237","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:42:01Z","timestamp":1771569721000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Diagnostic challenges in pediatric appendicitis: a case of perforated appendicitis with secondary hepatic abscess"],"prefix":"10.3389","volume":"14","author":[{"given":"Xueke","family":"Li","sequence":"first","affiliation":[{"name":"Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Clinical Research Center for Medical Imaging in Hubei Province","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Clinical Research Center for Medical Imaging in Hubei Province","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Clinical Research Center for Medical Imaging in Hubei Province","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Clinical Research Center for Medical Imaging in Hubei Province","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilian","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Clinical Research Center for Medical Imaging in Hubei Province","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e2023484","DOI":"10.1001\/jamanetworkopen.2020.23484","article-title":"Trends in appendicitis and perforated appendicitis prevalence in children in the United States, 2001\u20132015","volume":"3","author":"Gray","year":"2020","journal-title":"JAMA Network Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1038\/s41572-025-00659-6","article-title":"Appendicitis","volume":"11","author":"Salminen","year":"2025","journal-title":"Nat Rev Dis Primers"},{"key":"B3","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1308\/rcsann.2023.0055","article-title":"Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study","volume":"106","author":"Taib","year":"2024","journal-title":"Ann R Coll Surg Engl"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1093\/cid\/ciae348","article-title":"2024 clinical practice guideline update by the infectious diseases society of America on complicated intra-abdominal infections: diagnostic imaging of suspected acute appendicitis in adults, children, and pregnant people","volume":"79","author":"Bonomo","year":"2024","journal-title":"Clin Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1007\/s11604-025-01811-8","article-title":"Comprehensive review of pulmonary embolism imaging: past, present and future innovations in computed tomography (CT) and other diagnostic techniques","volume":"43","author":"Triggiani","year":"2025","journal-title":"Jpn J Radiol"},{"key":"B6","first-page":"621","article-title":"Acute abdominal pain in children: evaluation and management","volume":"110","author":"Buel","year":"2024","journal-title":"Am Fam Physician"},{"key":"B7","doi-asserted-by":"publisher","first-page":"764","DOI":"10.3238\/arztebl.2020.0764","article-title":"Acute appendicitis in childhood and adulthood","volume":"117","author":"T\u00e9oule","year":"2020","journal-title":"Dtsch Arztebl Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"109165","DOI":"10.1016\/j.ejrad.2020.109165","article-title":"Imaging of appendicitis: tips and tricks","volume":"130","author":"Monsonis","year":"2020","journal-title":"Eur J Radiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1089\/sur.2023.370","article-title":"Ultrasound assessment in children with suspected appendicitis: time to revise diagnostic criteria: a prospective cohort study","volume":"25","author":"Zouari","year":"2024","journal-title":"Surg Infect (Larchmt)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.jpedsurg.2023.10.028","article-title":"Diagnostic ultrasound for acute appendicitis: the gold standard","volume":"59","author":"Roberts","year":"2024","journal-title":"J Pediatr Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s44326-024-00002-5","article-title":"Ultrasonography (US) examination of acute appendicitis (AA): diagnosis of complicated and uncomplicated forms and when US is not enough","volume":"11","author":"Comune","year":"2024","journal-title":"J Med Imaging and Interv Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Di Saverio","year":"2020","journal-title":"World J Emerg Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s00383-024-05880-0","article-title":"Ultrasound and computed tomography in differentiating between simple and complicated appendicitis in pediatric patients","volume":"40","author":"Badlis","year":"2024","journal-title":"Pediatr Surg Int"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e2431337","DOI":"10.2214\/AJR.24.31337","article-title":"MRI for the diagnosis of appendicitis in children: expectations from a middle-income country","volume":"222","author":"Vasquez","year":"2024","journal-title":"Am J Roentgenol"},{"key":"B15","first-page":"11","article-title":"The diagnostic value of the computed tomography scan and ultrasonography in acute appendicitis","volume":"13","author":"Bahrami","year":"2023","journal-title":"Am J Nucl Med Mol Imaging"},{"key":"B16","doi-asserted-by":"publisher","first-page":"112695","DOI":"10.4291\/wjgp.v16.i4.112695","article-title":"Imaging of appendicitis: computed tomography, magnetic resonance imaging, and ultrasound in diagnosis and management","volume":"16","author":"Perera Molligoda Arachchige","year":"2025","journal-title":"World J Gastrointest Pathophysiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/PEC.0000000000001710","article-title":"Appendicitis: role of MRI","volume":"35","author":"Mittal","year":"2019","journal-title":"Pediatr Emerg Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e02442022","DOI":"10.1590\/0037-8682-0244-2022","article-title":"Pyogenic liver abscess following perforated appendicitis","volume":"55","author":"Aky\u00fcz","year":"2022","journal-title":"Rev Soc Bras Med Trop"},{"key":"B19","doi-asserted-by":"publisher","first-page":"104744","DOI":"10.1016\/j.amsu.2022.104744","article-title":"Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report","volume":"82","author":"Pahari","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"103","DOI":"10.4254\/wjh.v16.i1.103","article-title":"Pylephlebitis-induced acute liver failure: a case report and review of literature","volume":"16","author":"Hapshy","year":"2024","journal-title":"World J Hepatol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1089\/sur.2019.366","article-title":"Pyogenic liver abscesses caused by acute appendicitis: frequency and diagnostic and therapeutic recommendations","volume":"22","author":"Wichmann","year":"2021","journal-title":"Surg Infect (Larchmt)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.jss.2020.03.013","article-title":"Laparoscopy as a diagnostic and therapeutic modality for chronic abdominal pain of unknown etiology: a literature review","volume":"252","author":"Zhao","year":"2020","journal-title":"J Surg Res"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1784237\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:42:08Z","timestamp":1771569728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1784237\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":22,"alternative-id":["10.3389\/fped.2026.1784237"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1784237","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"article-number":"1784237"}}