Stress-related mucosal disease in childhood appendicitis

Stress-related mucosal disease (SRMD) is known to occur in critically ill patients both in the adult and paediatric population. Acute appendicitis is the most common surgical emergency in childhood and can precipitate SRMD. This possibility should be kept in mind, particularly in prolonged, complicated episodes. Although clinical complications of SRMD are rare, they may be highly significant in terms of haemorrhage or perforation and result in considerable morbidity or mortality. We provide a thorough review of the incidence, aetiology, role of Helicobacter pylori, risk factors, prophylaxis and management of this condition and describe a series of three cases of ulcerative SRMD in children with complicated appendicitis.