Appendicitis caused by inflammation of the structure at the junction of the small intestine and large intestine is more common in childhood. The disease that can be treated with surgery usually starts with pain around the navel. American Hospital Department of Pediatric Surgery View Egemen's Full Profile symptoms may vary in children, he says.
What is appendicitis?
Appendicitis is called inflammation of the worm-like structure at the junction of the small intestine and large intestine called 'blind intestine' in our society. Congestion occurs when the opening of this blind structure is closed as a result of hard stools, swelling of the islets or lymph islets on the wall. Normally secreted normal intestinal secretions can not come out of the clogged mouth begins to accumulate in the appendix and thus the infection, inflammation process begins. At this stage, the child will only feel pain and anorexia around the navel.
As the appendix slowly swells with infected secretions, the wall feeding begins to deteriorate and the infection spreads to all wall layers. In the meantime, the pain begins to settle in the lower right abdomen, fever, nausea and vomiting are added to the pain. When the appendix wall is completely damaged, the wall is punctured and infectious intestinal secretions are poured into the abdomen. In this period called explosive appendicitis, vomiting occurs with severe pain and fever in all parts of the abdomen. If there is still no intervention until this stage, it is inevitable for the infection to enter the blood, ie sepsis.
Who has appendicitis?
Although appendicitis can be seen in all age groups, this rate is slightly higher in childhood. The incidence in childhood is 0.4% and the most common age group is between 6-10 years.
What are the symptoms of appendicitis?
Acute appendicitis often begins with pain around the navel. Pain is followed by loss of appetite, nausea and vomiting. In the meantime, the pain slowly settles in the lower right abdomen and prevents the child to walk comfortably enough to make two bends. The child tries to avoid walking and standing, fever. The difference of appendicitis pain from most other abdominal pain is that it does not decrease in severity, is not transient and even increases gradually. With the explosion of the appendix, the whole abdominal wall causes pain and stiffness.
If your child has appendicitis, it should not be forgotten that not all the classic symptoms listed above may be present. Due to the fact that the appendix, which resembles a finger-like protrusion, can extend to very different places, it may produce different findings, especially with the addition of communication difficulties under 3 years of age, delays in diagnosis and treatment may occur.
How is it diagnosed?
Despite the advanced technology of appendicitis, the most definitive diagnosis is made by physical examination. As ancillary examinations, the high number of white cells in the blood count supports the infection.
Urinary tract urinary tract infections and urinary tract stones are considered. In cases of doubt, the abdominal ultrasonography exceeds 6 mm in diameter, the presence of free fluid around the last part of the large intestine, and the appearance of intestinal wall thickness and infected areas may help in diagnosis. Computed tomography, which is very effective in adults, does not have the same importance in the younger age group because of the weakness of children. However, in fat children, it can clearly show the present pathology because of the better appearance of fatty tissues.
What is the treatment? What happens next?
The definitive treatment is to remove the infected appendix and remove the abscess. The name of this surgery, which is called appendectomy in medicine, has two methods: open and laparoscopy.
In open appendicitis, the diseased tissue is removed by an incision in the right lower abdomen and the area is thoroughly cleaned. In the laparoscopic method, appendectomy is performed with the camera placed in the navel and with the help of two instruments placed right and left. The postoperative period is closely related to the period in which the surgery is performed. In early appendectomies, the patient can be discharged within a day or two, but in the late burst phase, this period can take up to one week. Nevertheless, each child can react differently.
The postoperative mortality rate has recently decreased to 0.5% due to increased antibiotic efficacy and improved diagnostic methods. Skin infections after appendectomy occur at a rate of 3% and can be easily treated. Intraabdominal abscesses, which can be seen especially after exploded appendicitis, can easily be treated by evacuation under tomography or ultrasound. Small intestinal adhesions that can be seen after appendectomy can be seen in 1-3%.
What is the differential diagnosis? What should families do?
Although appendicitis is common in childhood, diagnosis can be quite difficult in half of the patients. Diagnosis becomes more difficult especially in the patients under 3 years of age, mentally handicapped, hospitalized due to another disease, and young girls who may have abdominal pain due to gynecological reasons.
It should not be forgotten that one-third to one-half of the cases with appendicitis are children who have previously been seen by a doctor.
Mid-menstruation pain in young girls, pregnancy, egg rotation around itself, egg cyst; intestinal infections in childhood, pancreatitis, constipation, kidney stones, urinary tract infections, parasites; In younger children, infections, pneumonia, intestinal knot (knot: small intestine into the large intestine), such as discomfort, such as appendicitis may cause abdominal pain.
In case of non-regressive pain, vomiting (especially yellow-green, bile), fever, gas and feces starting around the umbilicus and settling in the right lower abdomen, it is necessary to consult with the pediatric surgeon without any pain medication in order to mislead the doctor's examination.