Acute appendicitis is one of the most common causes of abdominal surgery in children between 6 and 20 years old, hitting about 0.4% of children under 14 years of age.
Silvia, 10 years old, spent the weekend between birthday parties and visits from grandparents. But on Monday morning, while preparing for the school, he accuses a Strong stomach ache. The parents, thinking that it is only a pretext to avoid school, still send it to class but a few hours later, the teacher calls the parents: Silvia has intense pain, so much so that it cannot move; He has a fever and has eaten neither lunch nor snack. The parents, worried, rush to school and immediately bring it to the emergency room, where the diagnosis arrives: acute appendicitis.
THE’acute appendicitis in children it can manifest itself in different ways or with symptoms More evident and serious that require timely intervention. In this article, we will explore the signals to pay attention, the causes and methods of treatment of appendicitis in the child.
How to understand if a child has appendicitis
To avoid serious complications, it is fundamental recognize appendicitis in children. Any child or girl, who has not suffered an appendicectomy (i.e. the removal of the appendix, usually for a previous episode of acute appendicitis), It can develop this condition. Precisely for this reason, parents, pediatricians and emergency doctors must be aware of the alarm bells.
First of all, Age is a significant factor: children between 5 and 15 years old are the most affected. It is important to note that in younger children there is a greater probability of perforation. But what are the characteristics of appendicitis? The main symptom of appendicitis It is abdominal pain. It is therefore important to evaluate its characteristics, primarily the duration. If the story of Abdominal pain has lasted for monthswill rarely be caused by acute appendicitis. In fact, the debut of pain is generally acuteeven if it can manifest itself in a subtle way. Initially, the pain is located in the periomelical area and usually it is of the colic type (with waves that come and go); After a few hours, it tends to become continuous and moves to the right side of the abdomen.
This “migration” of pain is characteristic of appendicitis. The pain is such as to wake the child in his sleep and strongly limit the movements. An empirical test that can be effective in the event that there is a suspicion of appendicitis is the so -called jump test: If there is an inflammation of the appendix, the child will feel more pain if he jumps and, sometimes, he will not be able to do it for pain. Others Symptoms of appendicitis they include nausea And vomitwhich can initially be food and subsequently bile (yellow-greenish).
There fever It is common, typically slightly, but can increase in case of perforation. Again, theinhabitant and the absence of feces and gas They are signals not to be underestimated. Attention must also be paid to diarrhea, which can occur in the event of peritonitis. In children under five years, appendicitis is less common but can occur atypically, requesting immediate attention from the pediatrician. In these patients severe abdominal pain (The child appears suffering, does not play and does not behave as usual) must always be evaluated by the pediatrician and it is important to pay attention to other associated symptoms such as vomiting, diarrhea and obviously fever.
The diagnosis of acute appendicitis in children is mainly clinical, based on anamnesis and on the physical examination conducted by the pediatrician. Sometimes diagnostic tests are needed to confirm the diagnosis and evaluate the presence of complications such as pus or perforation. Blood exams include the bloodocromo with the white blood cell count and inflammation indexes (for example the Reactive C protein or PCR).
However, it is good to remember that the value of these exams is not opposing as they are late in a late way compared to the symptoms. The ultrasound is particularly useful in cases where there is a diagnostic doubt, especially if it highlights an appendix from the inspected walls and the presence of a payment around the appendix, signs that allow us to confirm the diagnosis of appendicitis acute. It is important to emphasize, however, that the absence of viewing the appendix in ecography does not allow us to exclude the diagnosis of acute appendicitis.
Causes of appendicitis in children
What are the causes of appendicitis? The appendixalso known as the vermiform appendix, is a small tube which extends from the large intestine, precisely from the blind man. Although its biological function is not yet clear, it is believed that can play a role in the immune system during the first years of lifethanks to the presence of lymphatic tissue. However, it is a non -vital organ, and its removal (Appendicectomy) has no negative health effects.
Appendicitis is the inflammation of this tube, generally caused by an obstruction. The structure of the appendix, rich in lymphatic tissue and with a reduced diameter, is predisposed to the formation of a “cap” caused by various factors, such as feces, mucus, foreign bodies, or an excess of lymphatic tissue. Among the foreign bodies we remember ingested foreign bodies (seeds or hazelnuts) and coprolitis (deposits of dehydrated feces that create small agglomerates hard similar to Sassolini). This obstruction leads to the proliferation of bacteria normally present in the intestine, causing a potentially serious inflammation, which can culminate in a perforation of the appendix and a peritonite, a condition that requires rapid diagnosis and urgent intervention.
But how frequent is the appendicitis in children? Acute appendicitis is one of the most common causes of abdominal surgery in the age group between 6 and 20 yearshitting about 0.4% of children under 14. It is less frequent in developing countries, probably due to genetic differences and eating habits.
How to take care of appendicitis
We are there, we recognized the initial symptoms and the doctor confirms the suspicion of appendicitis … and now? How to take care of appendicitis in children? Surgical advice is an important phase in defining the child’s path with appendicitis. The surgeon will decide the specific treatment taking into account factors such as the possible presence of complications, the age and general state of the child. In case of perforation of the appendix, surgical treatment is always necessary.
In particular, it is performed an appendicectomy in childrenthat is, the surgical removal of the appendix. The so -called “cooling” of the appendix, that is, the only medical treatment through antibiotics, is to be reserved only for specific cases after careful evaluation, in fact there are risks of appeals of appendicitis itself, often in even more serious form. The appendix operation in children can perform by two ways: the traditional or laparoscopic one.
In both cases the child is asleep with general anesthesia and the appendix is identified and removed. The traditional intervention involves the execution of an incision on the abdomen, the laparoscopic way instead involves a small incision on the abdomen through which a micro camera and surgical tools are included in the child’s abdomen to remove the appendix.
Immediately after the intervention the child will not be able to drink or eat And it will be hydrated intravenously, sometimes administered together with an antibiotic therapy to protect it from any infections in the first days after surgery. Subsequently the child will start eating and once removed any drainage and resumed the power supply, it can be discharged. Generally the hospitalization lasts a period variable from 2 to 5 days. In the case of complications such as peritonitis, the hospital hospitalization could last for a few more days, on average between 7 and 10 days.
Once back home, despite the removal of the appendix does not involve negative effects on health, it is important to follow some indications for guarantee correct healing. It is necessary to avoid wetting the wound until complete closure. One could be prescribed antibiotic therapy And a gradual diet must be followed. The return to school and normal activities can take place on the basis of the resumption of the general conditions of the child and the evaluation of the doctor. It is recommended to wait about a month to resume more intense sports activities.
In conclusion, intercepting the signs of appendicitis early can make a difference in a child’s life. Being informed and ready to recognize the symptoms will allow to intervene promptly to implement suitable therapy.
