Acute appendicitis
Overview: Acute appendicitis is an acute inflammation of the appendix and is the most common acute abdominal disease in children, with a slightly higher incidence in boys than in girls; it is most common in school-age children between 6 and 10 years of age, with a lower incidence in younger children and a significant decrease in those under 5 years of age, accounting for only 1% of those younger than 1 year, and rare in newborns.
Pathological subtypes.
1.Acute simple appendicitis
2.Acute suppurative appendicitis
3, gangrenous and perforated appendicitis
4. periappendiceal abscess
Clinical manifestations.
1.Abdominal pain: It is the most common, obvious and earliest symptom of acute appendicitis. The abdominal pain starts from the umbilicus and is paroxysmal from mild to severe, and after a few hours the pain gradually shifts to the appendix in the right lower abdomen, mostly persistent dull pain with increasing paroxysms.
2. Nausea and vomiting: It often occurs a few hours after the abdominal pain starts, and some children may vomit first. In the early stage, vomiting is mostly food, but in the later stage, the vomit is yellow-green bile and gastrointestinal fluid, and the amount of vomit is large.
Diarrhea: If the appendix invades the pelvis, the inflammation stimulates the sigmoid colon and increases the number of bowel movements.
4, fever: body temperature around 38 ℃, mostly abdominal pain followed by fever, and gradually increase with the aggravation of the disease.
5, abdominal pressure pain: right lower abdomen wheal point fixed pressure pain is a typical sign of acute appendicitis.
Ancillary tests.
1, blood phase: total white blood cell count can rise to l.2 ~ 14,000 / mm3; and neutrophils accounted for 85% ~ 95%, such as neutrophils increased to more than 85% more reactive disease, sometimes also visible poisoning particles. But there are individual appendicitis children since the cell rise is not obvious.
2, for difficult cases should do laparotomy, by microscopic examination with pus cells, can be diagnosed.
3.CT can directly show the appendix and surrounding soft tissues and inflammation.
4.B ultrasonography shows no image of normal appendix under B ultrasound, more than ≥6 mm can determine the diagnosis of appendicitis, and the width of appendiceal cavity increases, showing the size of the abscess around the appendix.
Complications.
1, appendiceal abscess abdominal abscess
2, appendiceal perforation
3, peritonitis
4, portal phlebitis
5.Sepsis
6.Infectious shock or even death
Treatment.
Early surgical treatment of acute appendicitis, regardless of the type, in principle.
Conservative treatment can be tried in the following cases.
1, the onset of more than three days, the condition is relatively stable, there is a local inflammatory mass, there is appendiceal abscess formation, 3 months after the inflammation subsides and then appendectomy.
2. Those who have a tendency of limiting peritonitis, lower abdominal pressure pain and right lower abdominal inflammatory infiltrate have been reduced. In the course of treatment, if the body temperature rises, the abscess mass grows larger, the abdominal pressure pain increases, and the white blood cells rise significantly, surgical drainage should be considered.