Abstract
Modern diagnostics of acute appendicitis in children should include abdominal ultrasound investigation upon admission to a specialized hospital, if necessary, in an ultrasound monitoring mode during clinical dynamic observation of the child. Surgical treatment is indicated only for destructive appendicitis. The method of a surgical treatment choice is laparoscopic surgery including destructive appendicitis complicated by appendicular peritonitis. Surgeries in acute appendicitis make up 75% of all emergency surgical interventions. Annually only in the Republican Research Centre of Emergency Medicine 700 appendectomies in children are made on average. The article summarizes data obtained in the retrospective analysis of case histories of 6 256 patients with acute appendicitis and its complications who were hospitalized in the pediatric department of emergency surgery for 12 years. The following incidence of acute appendicitis in children is reported: from 1 to 3 years old - 0.6 per 1 000; from 4 to 7-1.4 - 2.6 per 1 000; 13 years of age - 8 per 1 000. The authors discuss specific features in the clinical picture of acute appendicitis in children depending on patient’s age and anatomical location of the appendix. The clinical picture in children of older age and of the first three years of life is discussed separately. Among 6 256 pediatric patients with acute appendicitis 72 (1.15%) were children younger than 3 years. The authors have substantiated a complex of diagnostic and therapeutic manipulations as well as tactic options to the treatment of this category of patients. Widespread implementation of the laparoscopic technique into surgical practice has significantly changed the tactics of treatment. The number of surgeries for simple appendicitis in children has decreased up to 3.9-7%.
Highlights
Acute appendicitis in children as well as in adults is the most common surgical disease requiring emergency surgery
For making a diagnosis all patients with a clinic of acute appendicitis and with suspected acute appendicitis were hospitalized in the departments of pediatric surgery and examined according to the standard
The difficulties of diagnosis are exacerbated by the difficulties of examining children and identifying objective local signs of the disease. Their reliability depends on many factors. The influence of these factors is especially evident in the recognition of acute appendicitis in children of early age
Summary
Acute appendicitis in children as well as in adults is the most common surgical disease requiring emergency surgery. Surgeries in acute appendicitis make up 75% of all emergency surgical interventions. And correct diagnostics is the key to successful treatment of surgical diseases in children. Due to the anatomical and physiological characteristics of children (the most difficult age is up to 3 years), the diagnostics of acute appendicitis in children, especially at an early age, causes difficulties even for qualified pediatric surgeons [3]. It is important for surgeons to be able to distinguish acute appendicitis from a number of non-surgical diseases of childhood, often simulating a picture of acute appendicitis. The ability to differentiate the disease is an indispensable condition for making the correct diagnosis, preventing complications and achieving the ultimate goal - the child’s recovery [2, 4]
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