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[Acute appendicitis in the child]
1Kinderchirurgische Abteilung, Universitätsklinikum Benjamin Franklin der FU Berlin.
Insights
Acute appendicitis is a common cause of abdominal pain in children over one year old. Diagnosis relies on imaging like ultrasonography and often requires laparoscopic appendectomy for treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Context:
- Appendicitis is the most frequent cause of acute abdomen in children over one year of age.
- Incidence is low in children under two years, with a familial tendency.
- Symptom progression is rapid in younger children, presenting initially as non-specific abdominal pain.
Purpose:
- To review the diagnostic and therapeutic approaches for acute appendicitis in pediatric patients.
- To highlight the role of imaging and surgical interventions in managing pediatric appendicitis.
Summary:
- Appendicitis presents with varying pain characteristics due to anatomical variations in children.
- Laboratory tests have limited reliability; ultrasonography, particularly Graded Compression Sonography, is crucial for diagnosis.
- Laparoscopic appendectomy is recommended for treatment, offering advantages over conventional methods, especially in recurrent cases or for diagnosing other abdominal conditions.
Impact:
- Accurate diagnosis and timely surgical intervention, primarily laparoscopic appendectomy, are key to managing pediatric appendicitis.
- Advanced imaging techniques improve diagnostic accuracy, reducing the rate of missed appendicitis.
- The lethality rate for acute appendicitis in children is zero with appropriate management.
Abstract:
The appendicitis is the commonest cause of an acute abdomen in children older 1 year of age. Only 5% of children with appendicitis are younger than 2 years of age. There is a familial preponderance. The younger the child the faster the symptoms of the disease are increasing in intensity. The symptoms starts with unspecific periumbilical or epigastric pain, followed by nausea, vomiting and restlessness at night. Finally the pain moves to the position of the appendix. The position of the appendix shows a high variation in children thus the pain characteristic is not uniform. Laboratory tests are not reliable but ultrasonography is recommended to exclude other diseases and to try to confirm the diagnoses. With the technique of "Graded compression Sonography" the rate of non identified appendicitis has been reduced under 5%. Laparoscopy is another option. Its use just for diagnostic purposes is limited but is recommended widely for primary therapeutic treatment with laparoscopic performed appendectomy. Laparoscopy has a special advantage against conventional appendectomy in the diagnostic of recurrent unspecific abdominal pain in children and in cases with interval appendectomy. Finally in pseudoappendicitis and pseudoperitonitis in children with immunvasculitis and other extraabdominal diseases. Letality of the acute appendicitis is zero.