Acute appendicitis in children

Acute appendicitis is an emergency pathology of abdominal surgery, which consists of inflammation of the appendix.

This disease is the most common reason for a child to see a surgeon.

The key to successful treatment is early diagnosis.

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Epidemiology

Acute appendicitis is the most common surgical disease in children (4: 1000).

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Symptoms of acute appendicitis in a child

In school-age children and adolescents, appendicitis develops more often than in preschool-age children and often has clinical signs similar to those in adults. In younger children, the disease is especially difficult to diagnose because it is accompanied by nonspecific signs.

Symptoms of acute appendicitis in children are extremely diverse and variable depending on the age of the patient and the characteristics of reactivity, the severity of the inflammatory process, and the location of the appendix in the abdominal cavity.

In preschool and school-age children, pain often occurs in the epigastrium or near the navel and only after a few hours is localized in the right iliac region. The pain is usually of a constant aching nature. Vomiting and nausea are frequent, but not constant symptoms of acute appendicitis. Body temperature is normal or subfebrile. The general condition of children with acute appendicitis worsens as the inflammatory phenomena increase. The tongue is coated with a white coating. Symptoms of peritoneal irritation (Shchetkin-Blumberg, Sitkovsky, Rovsing) in children are less reliable than in adults. Typically:

• tension in the muscles of the right iliac region during palpation of the abdomen;
• an increase in rectal temperature by more than 1 °C compared to axillary temperature;
• tachycardia that does not correspond to the body temperature level;
• in the blood - leukocytosis, neutrophilia with a shift to band cells, increased ESR.

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Diagnostics of acute appendicitis in a child

Laboratory tests, ultrasound, computed tomography or magnetic resonance imaging are the main ones in diagnosing appendicitis at this age.

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Treatment of acute appendicitis in a child

Suspicion of acute appendicitis requires the involvement of a pediatric surgeon in monitoring the child. Treatment of acute appendicitis in children is surgical.