Acute appendicitis

Acute appendicitis

The cause of abdominal pain in children can be other diseases, it is especially important not to miss the symptoms that may be caused by acute appendicitis. What symptoms should parents pay attention to, in what cases should they consult a doctor, how is diagnosis done and what kind of surgical interventions are needed? The head of the children's surgery department of our clinic, TSU professor Merab Buadze, talks to us about these issues.

Inflammation of the intestinal tract or appendicitis is the most common disease in children, compared to adults, acute appendicitis in children is clinically more severe and diagnosis is difficult, which is due to its anatomical and physiological features. In particular, in the first months after the birth of the child, the appendix usually has a funnel-shaped shape, a wide base and a thin top, as if it is a separate bulge of the cecum, and only later it takes the form that is characteristic of adults. In addition, the opening from the caecum to the rectum, e. year Herlach's valve is open in newborns, which begins to develop from the age of 1 year and is finally formed at the age of 6-7 years, due to this, favorable conditions are created for the emptying of the intestine at this age, and there is no place for the contents to accumulate in its lumen. In children, acute appendicitis progresses more acutely and malignantly than in adults, which is due to some age characteristics, in particular, as is known, the peritoneum protects the organs of the abdominal cavity from healing with each other. The peritoneum also has the ability to fight infection. If the primary source of infection is removed in time, it completely manages to eliminate its consequences. Unfortunately, this feature of the peritoneum is well expressed only in adults, the younger the child, the peritoneum has less ability to resist infection, so the purulent process in children spreads relatively easily and quickly in the abdominal cavity.

There is also a large bladder in the abdominal cavity, which hangs down like an apron and covers the organs of the abdominal cavity from the front. It is known that the abdomen plays a major role in protecting the organs of the abdominal cavity and is called the "guardian" of the abdominal cavity. In small children, the bladder is poorly developed: it is short and thin, which is why it cannot participate in limiting the inflammatory process. As a result of the incomplete development of the appendix at this age, appendicular infiltration occurs much less often than in adults, and the disease takes the form of widespread purulent inflammation from the beginning. A typical clinical picture of acute appendicitis consists of the following main symptoms:

stomach-ache;
rise in temperature;
Vomiting
Stretching of the muscles of the front wall of the abdomen;
Leukocytosis.

Abdominal pain usually develops gradually and has a permanent character. In the first hours of the disease, pain is observed in the entire abdomen or in the epigastric area. Later, the pain is localized in the right hip fossa, which intensifies during movement. During attacks, patients are forced to lie down, preferably on the back or right side, as the movement of the cecum and inflamed appendix aggravates the pain. The pain sometimes becomes quite intense and is related to the stretching of the appendix filled with pus.

Vomiting is a very common symptom of acute appendicitis in children, which is observed on the first day of the disease, usually one or two times. Later, with the development of peritonitis, vomiting has a more persistent character and bile is mixed with the vomited mass.

 

Body temperature, as a rule, does not exceed -37.5 degrees, only in the case of a complicated form of appendicitis (diffuse periappendiceal abscess, infiltrate in the stage of abscessation) it reaches 39 degrees and maybe more. At the same time, we must remember that in some cases, the temperature can be normal at any stage of the disease, and during the operation, destructive changes and even perforation of the appendix will be found.

In children with acute appendicitis, there is an incomparability between the pulse rate and temperature increase, which indicates the transition of the inflammatory process to the peritoneum and general intoxication.

Clinical manifestations of acute appendicitis in children of early age (up to 3 years) are characterized by a number of features, which are manifested primarily by the fact that the clinical picture is dominated by general symptoms that are characteristic of many other diseases of this age. If in older children the main complaint is pain in the right iliac fossa, in children of early age there is no direct indication of pain, and the presence of this symptom should be considered only by indirect signs. The most important among them is the change in the behavior (character) of the child, in particular, the parents note that the child is relaxed, fussy, does not come into contact well. The fussiness of the child is associated with increased pain, which causes sleep disturbances, etc. Sh.
A fairly constant symptom is multiple (3-5 times) vomiting, which is a sign of appendicitis in children of this age.