Appendicitis in children

Acute appendicitisis the most common surgical disease in children. The inflammatory process in children occurs rapidly, resulting in the development of destructive changes in the process in a relatively short time. Children in the inflammatory process easy involved the peritoneum. The frequency of acute appendicitis is different in different age groups: in the nursery age accounts for about 5%, at the pre - 13%, to school - more than 80%.
In children, since 4-5 years of age, you can usually find out what the disease began with abdominal pain localized in the right half or spilled all over his stomach. Observed usually one or two vomiting, the temperature in most cases, low-grade (37,5-e), moderate leukocytosis (10 000-15 000). In toddlers (up to 3 years) clinical picture of appendicitis is dominated common symptoms over local. Often marked repeated vomiting, decreased activity, sleep disturbance, chair can be quickened, temperature reaction is more severe. Crucial in diagnosing have symptoms detected during the inspection of the sick child and palpation of the abdominal wall.
Palpation necessarily produce warm hands, starting with the left iliac region and gradually turn to the right, trying to distract the child's attention. Important features are a pain and passive muscle tension in the right iliac region, as well as positive symptom Shchetkina - Blomberg. Identifying these is objective evidence that the harder it is, the lower the age of the child. Difficulties of contact with sick toddlers, motor excitation and negative attitude to the survey does not allow to identify local tenderness and to distinguish passive muscle tension from active. To better identify these critical local signs of appendicitis in children under 3 years palpation of the abdomen performed when the child is in a dream. Sleep can be caused artificially by means of medication. For this purpose through the rectum (in the presence of a doctor) after cleaning enema impose a 3% solution of chloral hydrate rate of children under 1 year of 10-15 ml 1-2 years 15-20 ml 2-3 years - 20-25 ml fall asleep during which active muscle tension is released and remains passive, best detected symptom Shchetkina - Blomberg.
Complications of acute appendicitis in children: perforation of the Appendix, peritonitis, periappendicular infiltrate and periappendicular abscess. Infiltrate more likely to develop on the 3rd - 5th day of illness, in some cases, it may be resorption. With festering infiltrate temperature increases and increases leukocytosis, appear sharp pain on palpation of the abdomen and symptoms of peritoneal irritation. In the diagnosis of appendiceal infiltrate great importance digital examination through the rectum. When signs of sepsis infiltrate shown an emergency operation to avoid rupture of the abscess into the abdominal cavity.
Differential diagnosis of acute appendicitis is carried out with acute pneumonia, rheumatic fever, acute infectious and diarrhoeal diseases, cholecystitis, pancreatitis, complicated cysts and tumors of abdominal cavity, renal colic, hemorrhagic vasculitis, ascariasis, acute pyelonephritis and In other doubtful cases of sick children sent to the hospital for further diagnosis.
Treatment of acute appendicitis only online. The prognosis depends on the timing of the operation, so at the slightest suspicion of acute appendicitis child shall be directed to the surgeon.
Diagnosis of chronic appendicitis in children is quite difficult. Frequently recurring abdominal pain can occur when the helminthiasis, non-specific inflammation of the mesenteric lymph nodes, atony and spasm intestinal malformations or diseases of the urinary tract. To establish the diagnosis requires a thorough examination of a sick child in a hospital. Treatment of chronic appendicitis - operative.

Appendicitis in children is one of the most frequent diseases requiring emergency surgery. Most often observed in 8-12 years, however, the often ill children of preschool age. Unlike adults, appendicitis in children is characterized by rapid development of destructive changes in the process and peritonitis. Diagnosis of appendicitis is difficult due to the frequency of abdominal syndrome in children in many diseases, the complexity of collection of anamnesis and examination of a child younger children, who may prevail common symptoms and localized abdominal pain he does not know how. Muscle tension identified by comparative symmetric palpation, is localized in the right iliac region, but also occurs in the lumbar, suprapubic area and right upper quadrant; the little restless children voltage define in a dream. Vomiting is usually one or two children up to three years is repeated. Stool often delayed or normal. Temperature 37-38 degrees, the leucocytosis with a shift leukocyte left to 12 000-15 000. In some cases of appendicitis can proceed without leukocytosis.
During the examination of a child with suspected appendicitis differential diagnostics is carried out with pneumonia and pleurisy, with renal diseases, parasitic infection often ascariasis), coprostasis and abdominal syndrome (see), observed in various diseases in children, in particular - rheumatism, hemorrhagic vasculitis, measles, scarlet fever, flu, sore throat. Thorough examination of the patient to eliminate these diseases, as well as digital examination of the rectum contribute to further diagnosis. All any suspicious cases it is reasonable to refer the child to a surgical unit for dynamic observation.
Chronic appendicitis occurs in children less than adults. The diagnosis is based on a recurring pain in the right iliac region with increasing temperature, nausea. Indications for surgery in chronic appendicitis in children pose with caution after careful examination of the urinary tract (kidney stones), genitals, on eggs a worm and exception mesadenia (see), which is often caused by specific infection (tuberculosis).
Treatment of acute and chronic appendicitis - operative. The intervention is performed under anesthesia; in older children can local anesthesia. The process usually delete ligature method, without dipping stump (C. D. Ternovskii). In the absence during the operation of apparent changes in the process of producing a revision of 50-70 cm ileum (Meckel's diverticulum), ovarian (apoplexy, adnexitis) and do a biopsy of the lymph nodes of the mesentery (mutagenic). Intraperitoneal administration of antibiotics shown in destructive A. with symptoms of peritonitis. Indications for tamponade of the abdominal cavity is limited due to the inclination of the children to the development of postoperative adhesive intestinal obstruction (see).
Forecast sharp A. if timely operations favorable; the mortality rate does not exceed 0.1%to 0.3%.