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[Current diagnostic-therapeutic trends in treatment of pediatric appendicitis]
R Malnati1, G Capasso, S Stagni
1Divisione di Chirurgia I, Istituto di Ricerca e Cura a Carattere Scientifico, Ospedale San Raffaele, Milano.
Insights
Abdominal sonography is a valuable tool for diagnosing acute appendicitis in children, accurately identifying inflammatory signs and aiding in differential diagnosis. This imaging technique helps differentiate appendicitis from other causes of acute abdomen, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Acute appendicitis is a leading cause of emergency surgery in pediatric patients.
- Accurate diagnosis is crucial for timely intervention and preventing complications.
- Abdominal sonography has emerged as a key imaging modality for evaluating acute abdominal pain in children.
Purpose of the Study:
- To evaluate the diagnostic utility of abdominal sonography in pediatric patients with suspected acute appendicitis.
- To assess the ability of sonography to differentiate appendicitis from other causes of acute abdomen.
Main Methods:
- Retrospective analysis of 102 pediatric patients who underwent appendectomy for appendicitis over five years.
- Sonographic evaluation of 36 patients within the last two years of the study period.
- Detailed assessment of sonographic findings, including liquid effusion and appendix morphology.
Main Results:
- Abdominal sonography identified signs of inflammation in 94.4% of evaluated patients, including liquid effusion and thickened appendix.
- Sonography provided a clear visualization of the acute inflammatory process.
- No septic or obstructive complications were reported in the sonography-evaluated group.
- Mean hospital stay was 6.35 days.
Conclusions:
- Abdominal sonography is a highly effective diagnostic tool for acute appendicitis in children.
- Sonography aids in differentiating appendicitis from other conditions causing acute abdomen.
- The use of sonography in diagnosing pediatric appendicitis can lead to improved patient management and reduced complications.
Abstract:
Acute appendicitis is the first cause of emergency surgery in children. Actually, emergency abdominal sonography has evolved in differential diagnosis of acute appendicitis in children to differentiate it from other causes of acute abdomen as mesenteric lymphoadenitis, acute right pyelonephritis, acute diverticulitis in Meckel's diverticulum, intestinal intussusception, regional enterits, primary peritonitis, anaphylactoid purpura of Henoch-Schonlein. The aim of this study is the evaluation of the usefulness of abdominal sonography in diagnosing acute appendicitis in our current series of pediatric patients. We have operated 102 patients afflicted by appendicitis admitted to the pediatric department of Ospedale San Raffaele, Milano in a period of 5 years and operated on for appendectomy. In the last 2 years 36 patients were evaluated with abdominal sonography. This diagnostic tool showed in 34 (94.4%) a liquid effusion, sometimes thick of the right iliac fossa. In 2 patients the appendix had thickened layers, was edematous and the lumen was clearly filled with debris. Abdominal sonography has given a clear cut picture of the acute inflammatory process of the appendix. None of these patients has suffered from septic or obstructive complications. Mean duration of hospital stay was 6.35 days (3-15 days). Differential diagnosis of acute appendicitis can be extremely variable, from simple, paradigmatic situations to the most intriguing ones. This concept is well emphasized by William Silen when he says that "differential diagnosis of acute appendicits is an encyclopedic compendium of every abdominal disease that causes pain" in the 11th edition of Harrison's Principles of Internal Medicine.(ABSTRACT TRUNCATED AT 250 WORDS)