Five-year-old Xiao Li was lying in a hospital bed with a bout of abdominal pain, and a group of parents were beside themselves with anxiety. The physician told them that Xiao Li has “appendicitis”, but due to the history of more than 5 days and the formation of appendicular mass, has missed the time of surgery, can only be treated with drugs, hospitalization time at least half a month.
There has been a popular saying in the community that “appendicitis is a minor problem”. But in fact, serious appendicitis can even be life-threatening. Many complications such as appendiceal perforation, peritonitis, appendiceal abscess, and intestinal obstruction are often encountered due to delayed diagnosis, which can cause lifelong suffering to the child.
Pediatric appendicitis, also known as pediatric acute appendicitis, is a common acute abdominal condition in children, with children over 5 years of age being the most common. The incidence is lower than that of adults, but the disease is more severe than in adults. The high complication rate and appendiceal perforation rate of diffuse membranitis, which can even be fatal, must be taken seriously. The younger the age of pediatric appendicitis, the more atypical the symptoms are. Perforation, necrosis, and diffuse peritonitis occur within a short period of time and can bring about serious complications and even death if not diagnosed and treated promptly, so they should be taken seriously.
Causes
The causes of morbidity are complex and are only known to be related to factors such as
1, bacterial infection
Bacteria reach the appendix through the damaged mucosa and blood circulation, causing acute inflammation. Such as epiglottitis, pharyngitis, tonsillitis, etc. Pediatric upper respiratory tract infections, tonsillitis, etc. make the appendiceal wall reactive hypertrophy and blood flow obstruction, which can also be a cause of appendicitis;
2.Appendiceal lumen obstruction
Obstruction of the appendiceal cavity by fecal stones, foreign bodies (kernels, roundworms), twisted appendix, narrowing of the lumen scar, etc., leads to increased pressure in the cavity due to the retention of secretions and impaired vascular circulation in the appendiceal wall, which is conducive to bacterial invasion and bacterial reproduction, which is also a more common cause of acute appendicitis. If the appendiceal cavity is blocked for a long time, it will cause blood circulation disorders in the appendix itself, resulting in tissue ischemia, which will lead to appendiceal necrosis and perforation.
3.Nervous reflex
In children, bacteria in the intestinal tract invade the appendix due to cold, diarrhea, and gastrointestinal tract dysfunction, causing appendicitis; when gastrointestinal tract dysfunction occurs, it is often accompanied by appendiceal vascular and muscle reflex spasm, causing obstruction of the appendiceal cavity and blood flow obstruction causing inflammation.
Symptoms
The possibility of appendicitis should be considered in children with fever and abdominal pain, and the necessary tests and observations should be performed. Children who cannot be excluded from appendicitis should be hospitalized for close observation. When the child is rocking and patting the child’s body while he/she is sleeping, if he/she resists or cries, he/she should be alerted and examined repeatedly.
1. Systemic symptoms are more serious
More serious, fever appears early, the temperature is mostly 37.5 ~ 38.5 ℃, can be as high as 39 ~ 40 ℃, the central instability of temperature and inflammatory response of young children is intense, and even chills, high fever, convulsions, convulsions and other symptoms may appear.
2.Abdominal pain
Due to difficulties in history taking and narration, a typical history of metastatic abdominal pain is often not obtained, the abdominal pain is more extensive, and sometimes the abdominal pain is not the first symptom. Persistent abdominal pain that starts in the epigastrium or around the umbilicus and shifts to the right lower abdomen after a few hours. In case of appendiceal cavity obstruction, it is accompanied by paroxysmal abdominal pain aggravated.
3.Gastrointestinal symptoms
Often obvious and prominent. Vomiting is often the first symptom, and the vomiting is heavy and long-lasting. Dehydration and acidosis may occur due to massive vomiting and inability to eat. Inflammation of the intestinal tract stimulates excessive bowel movement and causes diarrhea, while constipation is rare. After appendiceal perforation, rectal irritation symptoms such as frequent stools and shortness of breath can be seen.
4.Pressure pain and muscle tension
Most of the pressure pain points are above the McDonald’s point. Repeated examination may reveal obvious pressure pain in the right lower abdomen, and in infants and children with high appendix position and mobility, the pressure pain point is on the inner upper side. The child may appear reluctant to move, preferring to lie on the right side with the knees bent, and walking with the waist flexed. Should be patient, gentle and careful examination, and up and down, left and right for comparative examination.
5. Abdominal distension and diminished bowel sounds
Due to early peritoneal exudation, the function of gastrointestinal tract is inhibited, thus the abdominal distension and diminished intestinal sounds are more prominent.
6.Upper respiratory tract symptoms
The incidence of upper respiratory tract infections in pediatric patients is high, and these diseases may be a trigger for the development of pediatric acute appendicitis. Therefore, pediatric patients often have upper respiratory tract diseases before the clinical manifestations of acute appendicitis.
7. Anal finger examination
Anal finger examination has important practical value in identifying dysentery, enteritis and intussusception, and cannot be simplified in diagnosis. The right wall of the rectum is sensitive, and if the appendix perforates the pelvic cavity and accumulates pus, the finger examination can feel the edema and hypertrophy of the tissue around the rectum, and there is pressure pain obviously.
Disease characteristics
Pediatric acute appendicitis has the following characteristics.
1. Weak defense ability of pediatric organism
Due to the deficiency of humoral immune function, lack of complement and poor phagocytosis of neutrophils, coupled with unstable thermoregulatory function. As a result, hyperthermia easily occurs, leukocyte elevation is more obvious than in adults, usually around 15000, neutrophilic nuclei increase, and toxic symptoms are more serious.
2, the clinical symptoms of acute appendicitis in older children are similar to those in adults. children over 6 years old can complain of the site and nature of abdominal pain, and with examination, the diagnosis is easier. infants and children under 6 years old often lack the typical symptoms of metastatic right lower abdominal pain, and the abdominal pain and painful signs are often irregular, so the clinical misdiagnosis rate is high, with 63% reported.
3.Septic, perforated block
Pediatric appendiceal lymphatic tissue is abundant, the appendiceal wall is very thin, the muscle layer tissue is little, after inflammation lymphedema is serious, it can cause appendiceal cavity obstruction, blood flow obstruction, so it is easy to perforate. The younger the age, the higher the incidence of perforation, the less developed the greater the omentum, and the higher the incidence of perforation, the more diffuse peritonitis is formed after perforation, and it is difficult to adhere to form a limited abscess. Perforation can occur in septic appendicitis from 14 to 24 h after the onset of the disease.
Suggestions: If children have symptoms different from the usual abdominal pain, especially when accompanied by signs such as fever, go to a regular hospital in time to avoid delaying treatment. At home, parents can also try to press the right lower abdomen of the child to determine whether there is a pain response, and if the child obviously refuses to press, then they should be highly alert.