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[Appendicitis in early childhood]
1Abteilung für Kinderchirurgie, Universität Erlangen-Nürnberg.
Insights
Appendicitis diagnosis in young children (under 4) is challenging, leading to delayed treatment and high perforation rates (44%). Early clinical evaluation and X-rays are crucial for timely appendectomy in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Emergency Medicine
Context:
- Appendectomies are common surgical procedures in children.
- Young children present unique diagnostic challenges for appendicitis.
- Delayed diagnosis in pediatric appendicitis leads to increased complications.
Purpose:
- To analyze appendicitis cases in children under sixteen, focusing on diagnostic delays and outcomes in very young children (under 4).
- To compare perforation rates and symptom duration between young children and older children undergoing appendectomy.
- To evaluate the effectiveness of clinical examination and diagnostic aids in pediatric appendicitis.
Summary:
- A 5-year study of 550 appendectomies revealed that only 4% of patients were under 4 years old.
- Children under 4 had a significantly higher perforation rate (44%) compared to older children (12%).
- Delayed diagnosis, with a mean symptom duration of 3.4 days in young children, contributed to higher perforation rates. Leukocytosis (>15,000) was present in 81% of patients.
Impact:
- Highlights the critical need for prompt diagnosis and intervention in pediatric appendicitis, especially in children under 4.
- Emphasizes the diagnostic value of clinical examination and suggests X-ray imaging when appendectomy indications are uncertain.
- Informs clinical practice to improve outcomes for young children with appendicitis, reducing morbidity associated with perforation.
Abstract:
Between 1982 and 1987 550 appendectomies in children under sixteen years of age were carried out in our surgical department. Only 21 patients were children under 4 years of age, accounting for 4% of all patients. The perforation rate however, was 44% in contrast to 12% in older children. One reason is the more difficult, und therefore often delayed, diagnosis. The mean duration of symptoms of appendicitis in young children was 3.4 days. In the special case of perforated appendicitis the mean duration of symptoms was 132 hours, as compared with 42 hours in children without perforation. Clinical examination is decisive for the diagnosis. Fever and vomiting are non-specific symptoms, but frequently present. Some 81% of the patients had leukocytosis over 15,000. If there are any doubts about the indication for appendectomy, x-ray examination should be carried out as a further useful diagnostic procedure.