Intravenous immunoglobulin for neonatal isoimmune

Children find a rectal examination unpleasant and over a third experienced severe discomfort in this study. This is acceptable only if essential information affecting management is obtained. In this series, the diagnosis of acute appendicitis in over 90% of cases was made from the clinical history and abdominal examination. In two cases the rectal tenderness indicated the correct diagnosis. Rectal tenderness was present in 12%. of children who did not have acute appendicitis. It seems reasonable, therefore, to omit routine rectal examination in children in whom the diagnosis of acute appendicitis is obvious from the history and abdominal signs. It remains essential, however, in those with acute abdominal symptoms but with inconclusive or no abdominal signs. Pelvic appendicitis and abscess may yield very few abdominal signs. Our results show that the examination on discharge home seems to be a fruitless exercise; in no patient was any information gained that affected the decision already made that the child was fit to leave hospital. We conclude from this study that: (1) Rectal examination is unpleasant for children; (2) The diagnosis of acute appendicitis in children may be made in over 90% of cases without rectal examination; (3) When the diagnosis is uncertain a rectal examination is sometimes useful to diagnose pelvic appendicitis or other pelvic pathology; (4) Rectal examination is a very poor early indicator of pelvic sepsis after appendicectomy.