Phlegmonous appendicitis in a child

Phlegmonous appendicitis is a pathological condition characterized by the development inflammatory process in the appendix (appendix), with the formation of edema and abundant purulent exudate. The process is accompanied by abdominal pain, vomiting (1-2 times), diarrhea, fever up to high numbers. Phlegmonous changes in the appendix develop rapidly, therefore, if you suspect this disease, you should immediately seek help from a doctor.

Diagnosis of appendicitis involves the use of laboratory and instrumental techniques. A general analysis of blood and urine, ultrasound and CT of the abdominal cavity will help to identify the presence of an inflammatory process. In controversial cases, diagnostic laparoscopy can be performed.

Acute appendicitis is the most common urgent pathology faced by pediatric surgeons. It can occur at any age, but it is still more often diagnosed in patients over 7 years old. According to medical statistics, the largest number of sick children is between the ages of 9 and 12 (over 80%). In preschoolers, it is found in 13%, and in toddlers - 5%.

Treatment of the disease is only surgical. Conservative techniques will have no effect. The intervention must be carried out as soon as possible, since the inflammation of the appendix in childhood occurs much faster. As a result, destructive changes in the appendix increase in a short period of time. Delay can cause complications (peritonitis).

Phlegmonous appendicitis: why does it occur?

The phlegmonous form of appendicitis in children develops quite quickly - in 12-24 hours. To date, the reasons for the progression of the disease have not yet been precisely established, but provoking factors are known:

• mechanical obstruction of the appendix. This can lead to spasm, foreign body, abundant accumulation of dietary fiber, fecal stones, hyperplasia of lymphoid follicles, congenital anomalies (for example, bends and twists) of the appendix;
• penetration into the tissues of the appendix of pyogenic microorganisms from the intestine;
• overgrowth of connective tissue in the appendix;
• acute thrombosis of the blood vessels of the appendix;
• penetration into the process of the cecum of pathogenic microorganisms from another focus. This can happen if the child is sick with another disease of an infectious nature. Infectious agents with the flow of blood and lymph enter the appendix;
• helminthiasis;
• endocrine factor. In some cases, the development of inflammation occurs due to the fact that there are many cells in the appendix that produce the hormone serotonin;
• poor nutrition. Statistics are such that more often acute appendicitis is diagnosed in people who eat a lot of meat products, as well as foods rich in animal protein.

Children under two years of age suffer from acute appendicitis much less frequently than others. This is due, first of all, to the peculiarities of the appendix, as well as nutrition. Pathology is rarely diagnosed at this age due to insufficient development of lymphatic follicles in the appendix. The follicular apparatus is fully formed by the age of 6. WITH this age, the incidence of appendicitis increases.

Symptoms of pathology

Phlegmonous appendicitis is the third stage in the development of pathology. It is preceded by two more stages - appendicular colic and catarrhal. The clinical picture of the disease manifests itself very clearly - abdominal pain, nausea and vomiting appear. If in the early stages of development illness no help was provided - phlegmonous appendicitis develops.

General clinical signs:

• the symptoms of inflammation are becoming more and more pronounced;
• intoxication increases, the patient's condition worsens;
• clear localization of pain. An older child himself can point out where he hurts. The pain is localized in the right iliac region;
• nausea and vomiting (usually 1-2 times);
• the temperature rises above 38 °;
• sweating (cold sweat) increases;
• headache and weakness;
• Heart rate - 90-95 beats per minute (tachycardia);
• refusal to eat;
• if you press deeply on the location of the appendix, and then suddenly release it, then the pain will intensify (a characteristic feature);
• tension of the anterior wall of the peritoneum.

Signs of phlegmonous appendicitis in newborns and children under 3 years of age

Phlegmonous appendicitis in newborns occurs extremely rarely (isolated cases). Diagnosis is complicated by the fact that babies cannot tell what really bothers them. As a rule, with the development of phlegmonous appendicitis, children from this age group are capricious, pull their legs to the stomach, and do not allow the doctor to conduct an examination.

Signs of pathology:

• severe pain syndrome (the child does not allow to touch the stomach);
• vomit. In young children, it is multiple;
• refusal to eat;
• in young children, diarrhea is more often observed with phlegmonous appendicitis. For this reason, it is very important to monitor the water balance. In the feces, pathological elements may be present - streaks of blood and mucus;
• body temperature rises to critical levels;
• tongue moist and white coated.

If appendicitis is suspected, the child should be taken to a medical facility as soon as possible. Delay can cost life, especially for a newborn. The disease in young children develops very quickly.

Signs of phlegmonous appendicitis in children over 3 years old

In children over three years of age, appendicitis develops gradually. The first symptom is the appearance of abdominal pain. At the initial stages of the development of the disease, it is localized in the epigastric region or near the navel. Gradually "flows" into the right iliac region.

Signs of pathology:

• in the first hours the temperature is subfebrile. When phlegmonous appendicitis develops, it rises;
• tachycardia;
• single vomiting, refusal to eat;
• stool retention;
• tongue coated with white bloom.

Differential diagnosis of the disease is carried out with intestinal infections, poisoning, gastroduodenitis, acute pancreatitis, renal colic, adnexitis, pyelonephritis, torsion of the ovarian cyst.

If medical assistance is not provided in a timely manner, complications may arise:

• phlegmonous appendicitis will turn into gangrenous;
• peritonitis;
• perforation of the walls of the appendix;
• appendicular infiltrate;
• intestinal obstruction;
• peliflebitis of the veins of the liver;
• sepsis.

Phlegmonous appendicitis: how to identify it in a timely manner?

Since the clinical picture of phlegmonous appendicitis usually manifests itself very clearly, the doctor can make a preliminary diagnosis already on the basis of a survey of a small patient and his examination. To make an accurate diagnosis, it is necessary to resort to laboratory tests and instrumental diagnostics.

On palpation of the abdomen, muscle tension and sharp soreness are noted at the site of localization of the inflamed appendix. Symptoms of irritation of the peritoneum - Voskresensky and Shchetkin-Blumberg are positive. Examination of young children is often carried out in a state of physiological sleep. If the surgeon has difficulties in the diagnostic process, then he can also conduct a rectal digital examination.

In order, the child needs to pass a general blood and urine test. In the blood with phlegmonous appendicitis, leukocytosis is observed (11-15x10⁹ / l). In OAM, reactive leukocyturia or hematuria is often detected.

Instrumental methods for the diagnosis of phlegmonous appendicitis:

1. Ultrasound of the abdominal organs.
2. Radiography.
3. CT scan of the abdomen.
4. If necessary (for differential diagnosis): excretory urography, ultrasound of organs localized in the small pelvis, FGDS, sigmoidoscopy.

How to treat phlegmonous appendicitis?

At the slightest suspicion of inflammation of the appendix, hospitalization of the child is necessary. Before the arrival of an ambulance, it is forbidden to apply a heating pad to the baby's stomach, give him an enema, give him medications, in particular, laxatives and pain relievers.

Any form of appendicitis can only be treated with surgery. Conservative therapy will not give an effect. In pediatrics, preference is given to laparoscopic appendectomy, since this operation is less traumatic and the child recovers after it much faster. If the patient was diagnosed with one of the destructive forms of appendicitis (phlegmonous, gangrenous), then a decision may be made to conduct an open appendectomy.

Preoperative preparation (no more than 2-4 hours):

• cleansing enema according to indications;
• do not give the child to eat;
• infusion therapy;
• the introduction of antibacterial drugs.

Surgery is performed under general anesthesia. Its duration directly depends on how inflamed the appendix is ​​and what changes have already occurred in it.

Video: Acute, phlegmonous appendicitis: what is it?

Prophylaxis

The prognosis for timely surgical intervention is usually favorable. Mortality with phlegmonous appendicitis is quite low - from 0.1% to 0.3%. To reduce the likelihood of developing this disease in a child, it is recommended to adhere to simple recommendations:

1. Eat properly. The child should receive all the vitamins, minerals and nutrients he needs with food. His diet should include vegetables, fruits, fish, legumes, and more.
2. Treat chronic diseases in time.
3. Make sure that the child does not swallow foreign objects.
4. Observe your baby's regular bowel movements.

The course of appendicitis is sometimes atypical, therefore, at the slightest malaise, it is recommended to consult a pediatrician and a surgeon for diagnosis.

Sources:

https://diseases.medelement.com/disease/острый-аппендицит-у-детей/14345

http://www.rcrz.kz/docs/clinic_protocol/2015/2пг/Педиатрия/Хирургия%20детская/Острый%20аппендицит%20%20у%20детей.pdf

https://medi.ru/klinicheskie-rekomendatsii/ostryj-appenditsit-u-detej_14131/