Thermometric panel of the anterior abdominal wall and prognostic axillary-abdominal coefficient

Abstract

Complications of acute appendicitis in children, infiltrates, abscesses and peritonitis remain relevant in pediatric surgery because they are difficult to diagnose and they have clinical features. Finally, they make up 75% of the patients in the surgical departments which carried out urgent surgical intervention. On appendicular peritonitis accounts for up to 28% of children with delays in seeking medical help.In addition, despite the latest technology, 20% of patients with acute appendicitis is not installed on time and, as a consequence, the development of complications. Appendicular infiltrate is diagnosed from 0.2% to 14.6% of cases. Periappendicular abscess record in patients from 1.5% to 12.6%. Purulent inflammation of the greater omentum in the form of destructive appendicitis was diagnosed in 30% of patients under the age of 7 years and 70% of patients older than 7 years.On postoperative infiltrates and abscesses of an abdominal cavity has from 1.1% to 10.5% of patients of the total number of limited forms of peritonitis and to 40.3% of the patients with General peritonitis, as a complication of postoperative infiltrative omantic occurs in patients from 0.02% to 4.52%.In the diagnosis of important localization, reasons for the development of infiltrates, abscesses of abdominal cavity in children.Described in the guidelines for surgery in the first half of the twentieth century "softening" tumoroids for today practically does not occur. Feeling dense sedentary infiltration even during the operation makes it impossible to judge about the organ and tissue structure and the presence of abecedarian. Traditional laboratory data are not specific for the diagnosis of intra-abdominal infiltrates and abscesses. They characterize the presence of the inflammatory process and to some extent the intensity of inflammation.In recent years, among medical imaging systems septic foci and control of the postoperative period, takes its place remote infrared thermometry.Despite the use of modern methods of diagnosis and treatment, there is a stable mortality rate from 0.2 to 0.4%, while appendicularia peritonitis, they account for between 0.7 and 23%.Thus, from the above information it follows that at the present stage in the early stages of the formation of infiltrates and abscesses of abdominal cavity in children reliable verification difficult.Materials and methods. The work is based on the analysis of the results of thermometry of the anterior abdominal wall of 33 patients with appendicular infiltrates and abscesses of the abdominal cavity, who used remote infrared thermometry. The comparison group included 70 children who were hospitalized in the surgical department with suspected acute appendicitis. The age of patients ranged from 5 to 17 years (10,21±0,37 years).When determining the temperature of the anterior abdominal wall, patients were in a horizontal position on the bed with an open abdominal wall. After adapting the skin to the microclimate for 10 minutes, at an ambient temperature of 19-22°C, on an empty stomach and with an empty bladder. According to the scientific literature, the temperature of the anterior abdominal wall, in the absence of an inflammatory focus, is 34.2-34.6°C.The local temperature of the anterior abdominal wall was measured at 26 points, located on a plane forming the panel of the anterior abdominal wall, at the intersection at right angles of 5 vertical and 6 horizontal lines, starting from the upper divisions from right to left.Results. Thermometry has been shown to indicate the variability of the temperature of the anterior abdominal wall in children - various indicators for both primary and secondary infiltrates, abscesses of the abdominal cavity.The average temperature of the anterior abdominal wall in children without surgical pathology, according to measurements at the points of the thermometric panel, was 34,25±0,05°C. The average axillary temperature was 36,65±0,01°C. The prognostic axillary-abdominal coefficient (PAAC) in this group of patients was at the level of 2,43±0,07°C.In patients with infiltrates and abscesses of the abdominal cavity, PAAС had a value of -1,16±0,06°С<0°С – left shift, at the maximum point of hyperthermia (39,16±0,14°С) on the thermometric panel of the anterior abdominal wall. With primary abdominal infiltrates -0,82±0,08°С<0°С and 38,9±0,47°С, PAA -1,25±0,05°С<0°С and 39,28±0,14°C. In patients with a SAI development of -0,5°С<0°С and 37,9°С (one observation), and in the conditions of the development of SAA -1,57±0,21°С<0°С and 39,45±0,28°С. This indicator indicates the focus of inflammation and determines the boundaries of the spread of the inflammatory process in the abdominal cavity.Conclusions. In the postoperative period, the determination of PAAC allowed in 33.3% of patients to promptly correct the treatment and prevent the development of postoperative infiltrates and abscesses, in the absence of ultrasound signs of inflammation.