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[The diagnosis of appendicitis in childhood]
1Kinderchirurgische Abteilung, Bezirkskrankenhauses Heinrich Braun Zwickau.
Insights
Diagnosing appendicitis in young children is challenging, especially when complicated by respiratory illness. Prompt surgical intervention and careful observation are crucial for accurate diagnosis and improved outcomes in pediatric appendicitis cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Emergency Medicine
Context:
- Appendicitis is a common surgical emergency in children.
- Accurate and timely diagnosis in preschool-aged children (2-4 years) presents unique challenges.
- Co-existing conditions, such as respiratory disease, can complicate presentation.
Purpose:
- To analyze the diagnostic accuracy and clinical presentation of appendicitis in preschool children.
- To identify factors contributing to delayed diagnosis in this age group.
- To evaluate surgical outcomes and recommend diagnostic strategies.
Summary:
- This study analyzed 89 preschool children diagnosed with appendicitis, with 46 undergoing surgery.
- Perforated appendicitis (39%) showed typical symptoms like vomiting, abdominal pain, and fever, often with severe patient decline (80%) and ileus (50%).
- Respiratory disease was a common co-morbidity, delaying diagnosis, particularly in children under 3. Negative laparotomies occurred in 22%.
Impact:
- Highlights the difficulty in diagnosing appendicitis in young children, especially with concurrent respiratory infections.
- Emphasizes the need for vigilant monitoring and ward observation in uncertain cases.
- Underscores the importance of prompt surgical evaluation to prevent complications of perforated appendicitis in early childhood.
Abstract:
89 preschool children, 2-4 years old, treated under the diagnosis of appendicitis were analyzed. 46 of them were operated. In 39% of those children the diagnosis of an acute nonperforated appendicitis could have been ensured, in 39% the diagnosis of a perforated appendicitis was found, in 22% the was found, in 22% the laparotomy was negative. In cases of an acute perforated appendicitis typical symptoms were vomiting (100%), general stomach-ache (89%) and fever (61%). In most cases of an perforated appendicitis the state of patients was reduced drastically (80%), in 50% an ileus could be observed. Half a children with an acute nonperforated appendicitis as well as an perforated appendicitis had got a respiratory disease additionally. This fact was the main reason for the to late diagnosis particularly in the age up to 3. In all cases being not sure a consequent control at a ward is necessary; an important fact for this recommendation is the shortness of the acute perforated appendicitis in early childhood.