Acute appendicitis in children: features of the course of the disease

Inflammation of the appendix (appendicitis) is a common abdominal pathology that requires immediate surgical treatment. About 75% of emergency operations are associated with inflammation of the appendix of the cecum. Children from 3 to 10 years old are at risk, less often pathology occurs in adults. Acute appendicitis in children often proceeds under the guise of other diseases, so it is important for parents to know its causes, the first signs and symptoms, this will help to provide assistance in time and eliminate complications.

Content

1 Features of the disease
2 Causes
3 Varieties and severity
4 First signs and symptoms
5 How to distinguish appendicitis from other ailments
6 First aid
7 Diagnostics and possible complications
8 Treatment
9 Prophylaxis

Features of the disease

Appendicitis is understood as inflammation of the appendix, which is located on the right side in the epigastric region. There is still no exact data on the functionality of this organ, but many doctors believe that the appendix performs a secretory, barrier function, takes part in the creation of intestinal microflora. Outwardly, it is a narrow sac at the junction of the small and large intestines.

In children, the disease often manifests itself in an acute form with severe symptoms, accompanied by an increase destructive changes in the organ, which, if untimely provided medical care, can lead to purulent processes peritonitis and other life-threatening conditions.

According to medical observations, most often the disease affects schoolchildren, occasionally manifests itself in preschoolers and practically does not occur in children under 3 years of age.

Causes

There are several prerequisites for the development of acute appendicitis in children, but the exact causes are still unknown. Some scientific sources claim that the appendix contains lymphoid tissue, into which an infection can enter, which will provoke a secondary infection. Other factors can also act as the cause of an acute attack of appendicitis:

obstruction (blockage) of the lumen of the appendix;
congenital anomalies - bending of the appendix;
hyperplasia of lymphoid tissue;
helminths;
fecal stones (coprolites).

In children after 8 years of age, malnutrition or malnutrition can provoke acute appendicitis. Here we are talking about the use of junk food that causes "pollution" of the intestines: seeds, nuts, chips, crackers.

Chronic internal infections can also provoke an attack: caries, tonsillitis, sinusitis. If the child has a history of any infectious diseases, while the immune system is reduced, the risk of developing appendicitis is quite high. Regardless of the etiology, under the influence of unfavorable factors, hypertrophy of the lymphoid tissue occurs, the appendix increases in size, edema and inflammation develop. The first clinical symptoms appear within 5-10 hours from the onset of inflammation or after 2 days.

Varieties and severity

Acute appendicitis in children develops rapidly and can have several degrees of severity:

Catarrhal - manifests itself after 5-7 hours after the onset of inflammation. It is accompanied by a slight edema of the organ, an increase in its size. The child is worried about moderate pain in the abdomen, the body temperature rises slightly, nausea, and lack of appetite are worried.
Purulent (phlegmonous) - develops 18 hours after the onset of the first symptoms. There is an increasing edema of the appendix, which is filled with purulent masses. The inflammatory process affects all tissues. There is severe paroxysmal pain in the abdomen, an increase in body temperature above 38 degrees and other pronounced symptoms.
Gangrenous - manifests itself after 48 hours, refers to a severe stage, since the inflammatory process spreads to the adjacent organs of the abdominal cavity. The tissues of the appendix are susceptible to necrosis. The symptoms of appendicitis at this stage are expressed by intolerable pain in the abdomen, the body temperature rises to 40 degrees, the child's condition is serious, there is a high risk of complications.
Perforated (perforated) - at this stage, the walls of the appendix are ruptured, pus is poured into the abdominal cavity, peritonitis develops, which can lead to the death of the child.

First signs and symptoms

In children, the symptoms of acute appendicitis are acute, may be accompanied by atypical signs, which complicates early diagnosis. Typical clinical symptoms include:

pain in the abdomen, which is localized on the right side in the iliac region, aggravated by walking;
an increase in body temperature from 37.5 to 40 degrees, it all depends on the degree of inflammation;
nausea, often manifests itself before pain begins to bother and is present throughout the entire period;
vomiting is not always present.

One of the characteristic symptoms for acute appendicitis is Shchetkin-Blumberg syndrome, the presence of which is checked by pressing fingers on the stomach in the projection of the appendix. With an attack of acute appendicitis, the child will feel acute pain, which is evidenced by inflammation in the abdominal cavity.

In addition to the main symptoms, other ailments that are not entirely characteristic of appendicitis may disturb:

severe abdominal cramps;
Difficulty and painful urination
loose stools streaked with blood;
bloating.

Children often lie on their side, with their legs pulled up to the stomach. While walking, pull the leg.

Appendicitis is sometimes difficult to diagnose, since it can have quite different symptoms, especially if its attack develops in children under 5 years of age. Therefore, in the presence of the first signs, it is important to show the little patient to the doctor as soon as possible.

An attack of appendicitis in a child can be confused with an intestinal infection, so it is important to know about the symptoms that can be seen in the thematic video:

How to distinguish appendicitis from other ailments

Appendicitis is often "disguised" under other diseases of the gastrointestinal tract, so it is important to establish the correct diagnosis and distinguish it from other pathologies.

Pathology can be recognized by the following signs:

Ask the child to lie on their back and turn on their left side. If he complains that the pain is getting worse, it is most likely that there is inflammation of the appendix of the cecum.
Observe the behavior and movement of the child. With appendicitis, the child draws his knees to the chest, it is difficult and painful for him to lie flat.
With appendicitis, pain often radiates to the right leg, the child, when trying to walk around the room, will pull it.

First aid

If the child complains of severe abdominal pain, no pain medication should be given or antispasmodics, as they can hide symptoms while they develop in the abdomen inflammatory process.

It is strictly forbidden to put a heating pad or heat on the abdominal area, since warming compresses will intensify inflammation and lead to purulent processes.

The only thing that parents can do in case of an acute attack in a child is to call the ambulance team or deliver him to the hospital on their own. If the operation is not performed for the first 1-2 days, there is a high risk of developing peritonitis.

Diagnostics and possible complications

If appendicitis is suspected, the surgeon collects anamnesis from the words of the parents, conducts an examination, palpation of the abdomen, prescribes a number of examinations, including:

Ultrasound;
CT;
lab tests.

The results of the study allow us to determine the localization of the inflamed appendix, to exclude concomitant pathologies. Laboratory blood tests will help determine the inflammatory response and prepare the child for surgery.

Appendicitis is a dangerous disease, which, in the absence of timely diagnosis and timely operation, can lead to serious complications:

sepsis;
peritonitis;
abscess;
fistulas in the intestines;
pylephlebitis.

Any of these diseases are life-threatening and can develop before the child is admitted to hospital or after surgery.

Treatment

If there is suspicion of appendicitis, the child should be hospitalized in the surgical department, where, after examination and the results of the examination, an operation will be performed.

Acute appendicitis in children is an indication for emergency surgical treatment.

Modern surgery provides several treatments for appendicitis. Doctors prefer laparoscopic appendectomy, which belongs to the least traumatic, minimizes the risks of postoperative complications, shortens the recovery period.

Localization of pain in appendicitis

If the child was taken to the hospital late, purulent or perforated appendicitis has developed, the operation is performed by an open method. After the classic removal of appendicitis, a course of antibiotics is prescribed to eliminate the risk of secondary infection.

The duration of the operation to remove the appendix depends on the complexity of the pathological process, but generally does not exceed 2-4 hours.

On the first day after the surgical treatment, the child should not eat or drink; it is permissible only to moisten the lips with water. After 24 hours, it is allowed to eat a little low-fat and liquid food: broths, vegetable soup, tea with sugar. The portions should be small, the frequency of food consumption is 5-6 times a day. Full recovery from surgery takes 3 to 8 weeks. During this period, it is forbidden to eat spicy and fatty foods, exclude carbonated drinks and foods that increase gas production. To recover faster after surgery, you need to exclude physical activity, follow all medical appointments.

Prophylaxis

Despite the achievements of modern medicine, the exact cause of the inflammation of the appendix is not fully known, therefore, there is no prophylaxis that will protect a child from an attack of appendicitis. However, doctors give several recommendations that can reduce the risks of its development:

proper and healthy nutrition;
regular emptying of stools;
treat all concomitant diseases in time;
exclude excessive physical activity.

Acute appendicitis develops rapidly, therefore, at the first sign, you need to seek medical help, this will help to exclude the rapid progression of the disease, to eliminate the risks of complications.