1) Acute appendicitis and haematocolpos can have similar symptoms like abdominal pain, but have different causes - appendicitis is inflammation of the appendix while haematocolpos is a congenital condition where the hymen does not allow menstrual blood to exit the vagina. 2) The key differences are that appendicitis usually occurs in children and causes localized pain in the lower right abdomen, while haematocolpos occurs after menarche and causes cyclic abdominal pain. 3) A rectal exam can reveal an imperforate hymen bulging in the abdomen in haematocolpos, while signs of peritonitis are found in appendicitis.

1. DIFFERENTIAL DIAGNOSIS OF APPENDICITIS AND
HAEMATOCOLPOS
Department of pediatric surgery
Submitted by,
Al auf Jalaludeen

2. ACUTE APPENDICITIS
Acute appendicitis is the inflammation of the vermiform appendix. It is the most
common condition in childhood requiring emergency surgery.
In contrast to adults, children suffer more severe course of appendicitis and the
diagnosis is much more difficult.
Due to functional immaturity of the nervous system at this age, almost all acute
inflammatory disease have similar picture like, high body temperature, repeated
vomiting, intestinal malfunction.

3. • The inflammatory process in the vermiform appendix in the child is very violent, while
the mechanism of its demarcation are very weak.
• Specific difficulties in examination of infants exist restlessness, crying and resistance
to the examination make it difficult to detect the main local signs of acute
appendicitis.
• The rare occurrence of appendicitis in children under the age of 12 months is
explained by specific features of the anatomical structures of their appendix
(absence of stasis of the intestinal contents) and the character of diet at this age.

4. • There is no specific causative agent of acute appendicitis.
• The microflora proper of the vermiform process and intestine plays the
leading role in the development of inflammation.
Bacterial pathogenesis:
Escherichia coli, streptococcus, pseudomonas, klebsiella, clostridium,
bacterioides fragilis, etc
The infection may arrive by the hematogenous and lyphogenous route.

5. CLASSIFICATION
 simple
- catarral
 destructive
- purulent
- gangrenous
- perforated
 complicated
- infiltration
- abscess

6. CLINICAL SIGNS
• Constant abdominal pain in the right lower quadrant.
• Anorexia
• Nausea
• Vomiting
• Constipation
• High temperature

7. CLINICAL SYMPTOMS
• Filatov- strenghthening of pain by palpation in the lower right quadrant
• Kocher- transferring of pain from the epigastrium to the right lower quadrant
• Guarding- muscle tension in the right lower quadrant
• Shotkin- Blumberg- deep abdominal palpation with sudden withdrawal of the examination
hand causes pain
• Sitkovsky- strengthening of pain in the right lower quadrant when the turn of trunk on the left
side is going on
• Bartomier Michelson- tenderness by palpation of caecum is growing up when the patient is on
his left side
• Razdolsky- rebound tenderness by palpation in the right lower quadrant

8. DIAGNOSIS
• History (onset of symptom, pathological sighs)
• Patients position on the bed
• Palpation of symmetrical abdominal quadrants
• Rectal examination
• Laboratory investigation
• Ultrasound examination
• Electromyography
• Laparoscopy
• X-ray examination

9. DIFFERENTIAL DIAGNOSIS
• The differential diagnosis between acute appendicitis and hematocolpos is very
important because, it allows unnecessary appendectomy to be avoided in some cases
and true cause of abdominal pain.
• Haematocolpos is an abnormality of the hymenal caruncle of female, which is caused
due to failure of disintegration of the central cells of the mullerian eminence the projects
into the urogenital sinus.
• It is usually noticed in girls after the age of 14-16 years.
• It is a congenital pathology of female genitals. It may cause abdominal syndrome.
• As the uterus is functioning normally, the menstrual blood is pent up inside the vagina
behind the hymen.

10. • As the uterus is functioning normally, the menstrual blood is pent up inside
the vagina behind the hymen.
• Meslowly with parnstural blood accumulates in the vagina and sometimes in
the uterus due to congenital absence of natural orifice in the hymen called
hymen imperforatus.
• The disease usually starts with paroxysmal abdominal pain,weakness
indisposition and headache.

11. CLINICAL SIGNS
• Subfebrile fever
• Nausea
• Vomiting
• Pain (cyclic character and reoccurs every month for a year)
• Medical history supplies information on complete absence of menstruation
• Objective examination reveals an imperforated hymen which bulges out like a
dome
• Tumor like structure is detected in the lower abdomen by recto-abdominal
examination

12. TREATMENT
• Surgical removal of vermiform appendix
• Analgesics
• Antibiotics
• Disintoxication therapy
• Symptomatic treatment