Barium Meal and Follow-up in the Diagnosis of Chronic Appendicitis in Children with Recurrent Abdominal Pain: Is the Old War Horse Still Effective?

Background: Recurrent abdominal pain (RAP) in children presents a complex diagnostic challenge, with causes ranging from organic to functional and psychological. While most cases are benign, chronic appendicitis remains a rare but important consideration. Its atypical presentation and overlap with other gastrointestinal disorders make diagnosis difficult. Among the various diagnostic tools, barium meal studies, though not primarily designed to assess the appendix, can provide useful insights when combined with small bowel follow-through, potentially revealing subtle indicators of appendiceal pathology in children with RAP. Methods: A retrospective review was conducted on 20 children with RAP lasting 3-18 months, all previously evaluated for both functional and organic causes without a diagnosis. Ultrasound was unremarkable in all, and 17 had normal computed tomography scans. After clinical evaluation, all underwent barium meal and follow-through studies. Findings suggestive of chronic appendicitis, such as nonvisualization, mucosal irregularities, or filling defects, prompted laparoscopic appendectomy. All patients underwent regular postoperative follow-ups. Results: All children demonstrated imaging features consistent with chronic appendicitis and underwent laparoscopic appendectomy. Intraoperative findings were unremarkable aside from the appendix. Histopathology confirmed chronic inflammation, with mucosal fibrosis, lymphoid hyperplasia, and inflammatory infiltrates. Postsurgery, all patients reported complete symptom resolution. Conclusion: Though largely superseded by modern imaging, the barium meal with follow-through can still serve as a valuable adjunct in pediatric RAP cases, especially when conventional modalities are inconclusive or inaccessible. While no longer central in diagnosis, it remains a potentially useful tool in the broader diagnostic arsenal.