How to identify chronic or acute appendicitis in children. The first signs signaling the development of appendicitis in children

If a child complains of pain in the abdomen, nausea, vomiting, it can be either a banal poisoning or more serious illness such as appendicitis. Only experienced doctor put accurate diagnosis and solve the problem of the need for surgery. It is very difficult to recognize the symptoms of appendicitis on your own, since children have their own characteristics, and an atypical course is often observed.

This disease occurs in different age categories, children are most susceptible school age(8-15 years), preschoolers and infants get sick much less often due to anatomical features buildings digestive system.

The exact cause of acute appendicitis is unknown, it can only be attributed to a number of factors. The appendix has its own blood supply and innervation, an inflammatory reaction is provoked by blockage of its lumen. Fecal stones, worms, foreign bodies(fruit seeds, seeds), enlarged lymph nodes can disrupt the outflow of blood from the organ. As a result, it multiplies pathogenic microflora, damage to the walls is observed, at first only surface balls, later the inflammation acquires a purulent character, rupture of the organ with the development of peritonitis is possible.

Appendicitis in childhood proceeds much faster: if in an adult these stages take 2-3 days, then in a child the disease progresses significantly in a few hours. Therefore, it is necessary to recognize the first symptoms as early as possible and consult a doctor.

Increase the risk of developing an acute appendix:

• Excessive consumption of food, especially seeds, fruits with stones.
• The presence of worms. In addition to problems with digestion and stool, helminths, especially large ones, can crowd into balls and block the lumen of the appendix.
• Constipation provokes the formation of fecal stones.
• Diseases gastro- intestinal tract are additional factors.

Diseases in young children

Before 3 years, the disease is rare. The appendix is ​​wide, short, because the intestinal contents do not stay there for a long time, the risk of blockage is minimal. Nutrition mother's milk or grated cereals, soups positively affects motor skills, provides normal microflora. The lymph nodes appendix are underdeveloped, they cannot cause obstruction. Congenital anomalies of the gastrointestinal tract can provoke a disease at this age.

Signs of appendicitis in children infancy it is difficult to recognize, the disease manifests itself atypically, so you need to be attentive to any changes. Should be alert:

1. Crying, the cry of a child, bad dream, anxiety. Thus, the infant shows pain syndrome. The symptoms of appendicitis increase when feeding, changing clothes, when the position of the body changes.

2. Children choose a position that brings them relief.

3. Refusal to eat, decreased appetite.

4. Vomiting can reach 4-5 times, does not bring relief.

5. Liquid stool, pain when urinating. The child grimaces when he wants to go to the toilet.

6. The temperature often rises to 40 °C.

General symptoms

Acute or chronic appendicitis is always manifested by pain, the localization of which depends on the placement appendix. Only in 40% of cases it is in a typical place, and it can be clearly defined that the right iliac region hurts.

• Sometimes discomfort observed in the lower back, in the groin. This is a retrocecal localization of the process.
• When placed in the pelvis, the pain radiates down the abdomen.
• The appendix can reach the right hypochondrium, in which case the symptoms resemble cholecystitis.

A characteristic feature is the movement of pain. At first, the child may point to the navel zone, this indicates the initial stage of the disease, but if the right iliac region hurts, then the condition progresses, and it is required immediate intervention doctor. It is difficult to identify this symptom of appendicitis in children aged 3-5 years, since they cannot clearly determine where the discomfort is more pronounced, they always show the navel.

The organ of digestion is affected, because the signs of appendicitis include nausea and vomiting, which does not bring relief. At an older age, it is more often single, at a younger age it reaches 5-6 times a day. Stool disorders can be both in the form of diarrhea and constipation. For older age, as for adults, bowel retention is characteristic, in infants this liquid stool.

An increase in temperature depends on the severity of the disease, the spread of inflammation and the condition immune system organism. AT initial stages these are low-grade indicators, with purulent, gangrenous forms, the temperature reaches 40 ° C.

These symptoms indicate appendicitis, they should alert parents and force them to call ambulance. After all, the deterioration of the condition in children occurs very quickly, the sooner the operation is performed, the better the prognosis for recovery.

Diagnostics

The doctor first of all focuses on complaints, conducts an examination, then sends for additional laboratory and instrumental examination.

How to recognize appendicitis? To do this, the doctor uses a certain scheme so as not to miss the disease:

1. Complaints: pain in the abdomen, near the navel or in the right iliac region, nausea, vomiting, stool disorders, fever.

2. Objective examination: white-coated tongue, forced posture on the side with legs adducted, pain increases with a change in position.

3. Tension of the abdominal muscles, sometimes it is board-shaped, sharply painful on palpation. False muscle tension can be observed as defensive reaction, the result of fear. In this case, repeat the procedure when the child falls asleep. If the cause is inflammation, even in sleep the abdomen will be hard.

4. Checking for specific features. If you sharply press and then release in the right iliac region, the pain will intensify (this is a symptom of Shchotkin-Blumberg). In the position on the left side, the discomfort will become stronger on the right. Indicates acute appendix pain when trying to bend right leg in the knee joint.

5. General analysis blood confirms the presence inflammatory response. Leukocytes are the first to react, ESR rises, but these indicators are not always changed. In some cases, leukocytes may be normal or slightly elevated.

6. Urinalysis can detect red blood cells, white blood cells, bacteria. The reaction is especially pronounced in the pelvic localization of the process. The inflammatory process passes to the bladder, ureters, as a result of which the urine changes.

7. For differential diagnosis with appendicitis in adolescents, in particular, in girls, they are invited for a consultation with a gynecologist.

8. Ultrasound will reveal acute and chronic appendicitis. This method does not carry radiation exposure, painless, does not require additional preparation. The following signs will help to recognize the disease:

• The wall thickness exceeds 3 mm.
• The increased volume of the process.
• Echogenicity is increased.
• The inflammatory reaction can pass to the omentum, it will be edematous, with a double contour.

Ultrasound - best method detection of appendicitis in children. Perhaps not the most informative, but safe.

9. Computed tomography - additional research to clarify the localization, the presence of complications, which will facilitate the operation. For younger age this is a large radiation load, its use is undesirable. For appendicitis in a child 7 years of age and older, CT is allowed after assessing the harm-benefit ratio.

Features of therapy

If you experience even minor abdominal pain or other symptoms, you should call a doctor. Deterioration of the condition can occur quickly, complications are very dangerous. Therefore, it is necessary to know how appendicitis manifests itself, what to do before the ambulance arrives.

At home, in no case should you use a heating pad, this leads to the spread of infection, provokes a rupture of the appendix. It is also undesirable to take painkillers, antispasmodics. They blur the symptoms and make it harder for the doctor to diagnose.

The surgeon chooses the tactics of treating appendicitis, since the main method is surgery. If the appendix is ​​uncomplicated, a small incision (a couple of centimeters) is enough, through which the process is removed using a laparoscope. The intervention is minimal, after a week the child returns to his usual life, limits physical activity. In case of peritonitis or severe course the surgeon decides to expand the incision, then the rehabilitation will take longer.

Chronic appearance requires specialist supervision. If symptoms are rare, surgery is not always indicated, conservative treatment is possible. Parents should know how to recognize the disease already at early stages to provide timely assistance. Although the exact cause of acute appendicitis is not known, there are several ways to prevent the disease from developing. Balanced diet, observance of hygiene rules, good immunity, the fight against helminths will not allow inflammation of the appendix.

Inflammation of the appendix, or appendicitis, is a common pathology of the appendix of the caecum. It is easy to diagnose in medical institution with the help of special equipment, but ordinary parents in home environment need to know not only common features inflammation, but also physiology, etiology, types of complications, diagnostic techniques, and, most importantly, an algorithm of actions for suspected appendicitis.

Most of the symptoms that are characteristic of appendicitis can easily be attributed to a number of other childhood ailments. But most of them, such as: gastritis, food poisoning, otitis media, SARS, parents prefer to treat themselves.

And in the meantime acute appendicitis in children it develops one and a half times faster than in adults, and delay is fraught with the most sad consequences.

According to statistics, approximately 15% of children under 15 undergo surgery to remove an inflamed appendix. The most susceptible to the disease are babies aged 2-3 years, 7-8 years and 12-15 years. AT adolescence girls are especially at risk.

Most doctors attribute the development of pathology to contamination and blockage for various reasons of the appendix duct. This risk increases in proportion to the age of young patients.

AT early age the reason is new products for the body of babies, as well as dirt and other mechanical particles that enter the intestines from infancy, when children are teething and they put everything in their mouths in a row. According to the well-known doctor, Dr. Komarovsky, parents of children under 5 years of age should be more afraid of children's appendicitis, because the risk of complications is higher, but the opposite happens. There are prerequisites for inflammation of the appendix during times of stress, strong physical activity, injuries and falls.

The cause may also be the resulting tumor, a congenital anomaly (twisting, bending) or infection. This is possible if there is infection bowel or chronic inflammatory disease.

Many doctors note that the blockage of the appendix duct can be associated with the following mechanical fillers:

• fecal stone;
• helminths;
• blood clots resulting from a hematoma.

Classification of appendicitis in children

1. Depending on the nature of the course of the disease, it is divided into acute and chronic appendicitis.

Acute appendicitis

It develops very rapidly, bringing the state of the body to a critical moment already on the second day of the course of the disease. This is the most common form of the disease.

Chronic appendicitis

This is a sluggish type of disease. With such a disease, the patient from time to time complains of pain in the abdomen, sometimes turning into acute attacks accompanied by nausea, vomiting, fever.

After some time, the attack subsides, and the child can only feel discomfort and drawing pains on palpation of the abdomen.

1. Due to the variety of positions in which the digestive organs are located in the body, appendicitis is divided into a typical and atypical form.

Typical appendicitis

Typical is called inflammation of the appendix, which is located in the right iliac region, smoothly descending to the small pelvis. In this position, it is in the body in more than 80% of people.

Atypical appendicitis

Retrocecal appendicitis is the most common of the atypical inflammation cases, occurring in about half of cases. The appendix is ​​in the area right kidney, ureter, lumbar muscles, can fit close to them.

Pain in this location of the process is weakly expressed compared to the typical form, localized in the right hip joint, also a pain point often occurs in the lower back and in the groin. This can cause lameness, as the pain is aggravated by movement and it can be painful for the child to step on the foot.

The pelvic location is twice as rare as the previous type of atypical location of the appendix.

The location of the process under the liver is characterized by pain in the region of the liver.

Sometimes pain in children is localized in such places that the diagnosis of the disease is very difficult. The child may feel back pain bladder, in the stomach. Children under 5 - 7 years old may not at all determine exactly where the stomach hurts.

1. There is also a classification according to the stage of development of the disease. Each pathology develops along an individual path, and it is not at all necessary that the disease will pass through all stages. Surgery can stop the disease at an early stage in time.

catarrhal

The most common type of acute appendicitis, this form is the mildest and usually has no complications during the normal course of the operation. This form persists for about the first 12 hours of inflammation. Further, it passes into the phlegmonous type, which is accompanied by a deterioration in the patient's condition.

Phlegmonous

This is a destructive stage, coming after the catarrhal. It lasts for about a day. At this time, all the tissues of the appendix become inflamed. The mesentery (the organ that attaches parts of the intestine to the back of the peritoneum) swells and the disease moves to the wall abdominal cavity.

Gangrenous

It occurs on the second - third day, depending on the rapidity of the development of inflammation and is expressed in necrosis of the walls of the appendix.

empyema

Empyema is the result of blockage of the process by mechanical suspensions or due to scarring of tissues, as a result of which pus accumulates inside the appendix, tissue inflammation occurs. positive moment is the isolation of the appendix from other parts of the abdominal cavity.

Perforated form

This is a rupture of the wall of the appendix and the eruption of its contents into the abdominal cavity. At this stage, death is possible.

Symptoms of appendicitis in a child

• Pain in the abdomen is the very first and characteristic symptom of inflammation. Initially, the pain is localized in the center of the abdomen, then, with a typical location of the appendix, it goes to the right lower abdomen, where the process is usually located. In children with an atypical location of the organs of the intestinal tract, pain may, according to the type of location, manifest itself in the left lower abdomen, either in the back or in the pubis. It is important to remember that such pain can also be a consequence of the development of appendicitis.
• Temperature is a symptom accompanying any inflammation, which is more intense in children than in adults. In babies, the temperature at the catarrhal stage rises to 38 degrees and above, and when the disease passes into more severe stages, it can even reach 41 degrees, which in itself is fatal.

—FOOTNOTE— Acute pain in the abdomen, which is accompanied by a sharp rise in temperature in children, is already sufficient reason to immediately contact medical professionals.

• The patient's stool in most cases is liquid, accompanied by flatulence. In rare cases, there is reverse effect – .
• Language state. Depending on the stage of development of the disease, the tongue gradually begins to become covered with a white coating, at first only at the base, gradually spreading to the tip. At the gangrenous stage, the tongue is completely covered with a white coating, dry mouth is observed.
• Nausea and vomiting. Children are very sensitive to irritations of the mucous membranes, so quite often the development of appendicitis is accompanied by constant nausea and vomiting, resulting in dehydration and intoxication of the body.
• Urination. With the pelvic location of the appendix, there may be frequent urges to urination. But this symptom is by no means obligatory.
• The pulse in this disease is rapid.

Age manifestations of appendicitis in children

Depending on the age of the children, their perception of the disease and behavioral tendencies have significant differences, which is not surprising. For example, the symptoms of appendicitis in children at the age of 10 are not only external, like in infants, patients can describe them in detail, which is useful in diagnosis.

Inflammation of the appendix in children under 3 years of age

In children up to three years manifestations of appendicitis are judged mainly by outward signs and symptoms, since at this age children can tell almost nothing about their well-being.

Characteristic signs of the presence of pathology are the lack of appetite in the baby, insomnia or intermittent restless sleep, crying.

When the baby is calm, he lies motionless, because movements cause pain.

Symptoms of appendicitis in children aged 5-7 years

At this age, children already have the ability to conduct a dialogue about their well-being, they can respond to the actions of adults and comment on their feelings during palpation. Although it is not always possible for a child to understand his feelings, especially against the background of a general malaise, aggravated by an upset digestive system and high fever.

The behavior of the child is reduced to trying to lie down, finding a position in which abdominal pain is minimized. True, it can be quite difficult to force a child to allow adults to conduct an examination and diagnosis, because the child understands that this will hurt him.

Features of appendicitis in children under 12 years of age

Statistically, largest number operations among children under 15 years of age falls on the age of 10-12 years. This is due to the fact that the intestines of children and adolescents have not yet grown to the state of an adult, it is longer, which means that it is more prone to curvature and torsion. In addition, children at this age experience a lack of hygiene, and all this against the background of preparing the body for puberty and hormonal changes which affects the immune system and the state of the intestinal microflora.

Appendicitis in teenagers

Appendicitis among adolescents occurs in girls almost twice as often as in boys.

In boys, the disease can be confused with gastritis or another disease of the gastrointestinal tract or genitourinary system. But a visit to the doctor is indicated in all these cases, which means that the doctor will be able to make the correct diagnosis in time.

For girls, it's much more difficult. In adolescence, against the background of puberty, at the onset or before the onset of menstruation, girls often experience sharp pains lower abdomen. This condition can last for several days, and therefore inflammation of the appendix can simply mix with these pains and not be noticed until the onset of severe stages of the disease.

Therefore, parents should carefully monitor the well-being of girls and, in the event of other symptoms characteristic of appendicitis, immediately sound the alarm.

How to recognize inflammation of the appendix from the age of 15

In adolescents over 15 years of age, appendicitis manifests itself with the same symptoms as in adults. The differences in symptoms are as follows:

• The temperature is much lower - 37 degrees in the early stages of the disease and 38 in the later stages.
• Nausea can be episodic, vomiting single or double.

Diagnosis of appendicitis

Diagnostic methods at home

When examining a patient, the doctor may apply various methods diagnostics that do not require special equipment, which means that parents can use some of them on their own if it does not harm the child.

For example, a method called Dieulafoy's Triad. When examining and probing the right iliac region, the doctor pays attention to three signs of appendicitis: pain when pressed and when released, muscle tension and special sensitivity (hyperesthesia). Using this method, you can diagnose appendicitis with a probability of 99%.

Medical diagnostics

In the hospital department, blood is taken to determine the presence of an inflammatory process, as well as a urine test to diagnose kidney problems.

In addition, they apply instrumental methods diagnostics, such as ultrasound, laparoscopy, radiography, fluoroscopy, irrigoscopy.

Treatment of appendicitis in children. Operation

In fact, the only way inflammation treatment is surgical removal process.

Sometimes there are cases when acute inflammation goes away on its own, if the cause of inflammation somehow eliminated itself during the catarrhal stage of the disease. But the statistics of such cases is negligible, so it makes no sense to hope for it. Inaction is deadly.

In surgery, the operation to stop the process is considered one of the easiest.

But if you start it, then the operation to remove appendicitis with complications can turn into one of the most difficult in surgical practice.

Modern surgery provides endoscopic method removal of the appendix. With this type of intervention, the incision on the body is less than 3 centimeters, blood loss and tissue damage are minimal, and the likelihood of complications is practically excluded. True, this type of operation is indicated mainly at the catarrhal stage of the disease. If the disease has spread, then drastic measures are needed to stop its consequences.

How to help a child at home

First of all, waiting medical workers, the task is not to harm the patient, and to minimize the possible consequences.

Therefore, in order not to lubricate clinical picture diseases, you should not give the child medicines, especially painkillers, because the main doctor's appointment with initial examination- this is palpation of the abdominal cavity, in which it is required to understand how the sick organism responds to the doctor's actions. Do not apply heating pads to the abdomen and should refrain from folk methods medicine.

The main thing to do is to provide the patient with peace in the supine position.

Complications of appendicitis in children

Complications this disease can occur in two situations: in the absence of timely diagnosis and treatment, as well as postoperative period for a variety of reasons, from medical malpractice to physiological features and consequences of other diseases of the body.

The complications of appendicitis include such diseases as diffuse and local peritonitis, liver abscesses, sepsis, appendix perforation, infiltrate, various thrombophlebitis. Such complications often lead to the death of the patient, or, in best case, to months and years of recovery of the body.

Prevention of appendicitis

There are no such measures, having taken which one could speak of any reliable protection against this inflammation. However, there are a number of tips, following which you can say that your behavior will not cause the disease.

First of all, you need to monitor what the child eats. Healthy food is the key to health, because the child's immunity plays an important role in the fight against any disease and inflammation.

People say that eating sunflower seeds along with the peel can cause clogging of the canals of the process. There is a rational grain in this, because statistical studies were carried out in Spain. It turned out that there is a high percentage among children who, on the eve of getting into the hospital, ate this product.

Also, if possible, avoid stressful situations, injuries and bruises, timely conduct therapy and prevention against helminths.

Conclusion

In conclusion, it should be noted that there is no way to absolutely exclude the development of appendicitis in a child, but there are indications to increase the chances of avoiding it. In any case, if you suddenly suspect that your son or daughter has inflammation, then it does not matter who is to blame and what is the reason. The only important thing is to know what to do. And here's what you need to do: immediately call an ambulance.

Indifference of adults to the problems of children and modern possibilities Medicines give the treatment of appendicitis a positive prognosis in almost 99 percent of cases. And that means everything is in our hands.

Appendicitis in children is an inflammatory disease of the appendix belonging to the caecum. Pathology occurs due to a weakened immune system, malnutrition, hypothermia or damage to the body by viruses. Her characteristic symptoms directly related to the age of the child.

Up to 3 years, the lumen of the appendix remains very small, so children under 1 year of age rarely get sick with appendicitis.

From toddler age, the structure of the appendix gradually begins to approach the view of an adult. Acute appendicitis with minor clinical abnormalities manifests itself from the age of 7 to 12. B puberty the disease in a child proceeds as in an adult.

Forms of children's appendicitis

Signs of appendicitis in children are expressed depending on the form of the pathology. Acute inflammation surgeons are divided into several types:

1. catarrhal, characterized moderate inflammation and swelling of the mucous tissues of the peritoneum. This form is more common in medical practice, its symptoms are observed in 80% of patients of any age.
2. Phlegmonous. In this form, all layers of the appendix are involved in the process. Inside the process is filled with pus, small pustules jump up on the surface.
3. Gangrenous. At this stage, the walls of the appendix die off, and the tissues decompose.
4. Probodnaya. The worst case scenario in which the appendix bursts.

Chronic appendicitis in children is rare.

Early symptoms of appendicitis

At the initial stage of the development of pathology, pain in a child occurs unexpectedly and is localized above the navel with a gradual downward displacement. Sharp tremors and dull pains in the abdomen are early symptoms of inflammation of the appendix, but already require a visit to the clinic.

Then the picture changes. The pain becomes heterogeneous, spasms alternate with relaxation, aching pains, heaviness in the peritoneum. But the pain does not go away - it intensifies when walking, lying on your side and sitting. The child is overcome by weakness, nausea and vomiting.

Temperature indicators rise to 37 - 38 ° C. The specified range is included in the symptoms signaling a stable internal inflammation. Once the process reaches its peak, the temperature jumps to 39°C. There are no stool disorders in children with appendicitis. This allows you to differentiate the disease from gastric disorders, poisoning, and other ailments that have similar symptoms.

Inflammation of the appendix in a child under 5 years old

In a 5-year-old child and younger, the following symptoms help to recognize the disease:

• The baby is pale and thirsty;
• He has chills and a slight rise in temperature;
• The baby suffers from constipation or loose stools “pour” out of it;
• The kid is weakened, drowsy and capricious;
• Nausea is replaced by vomiting;
• Due to pain in the abdomen on the right, the baby tends to lie down on the right side and does not allow to feel the problem area.

Manifestations of appendicitis in children 6-14 years old

What symptoms accompany appendicitis in a student? Parents should be alerted by the lack of appetite and the child's complaints of constant nausea. Vomiting opens one-time or repeatedly. Chills occur, temperature fluctuations are observed. Acts of defecation pass without problems, but discomfort remain in the abdomen and resemble the pains of colic.

Symptoms of inflammation of the appendix up to 14 years of age completely coincide with the picture of the disease in adults. But the first subtle signs quickly reach severity, so it is important not to miss the beginning of the development of pathology.

How to recognize inflammation of the appendix from the age of 15

Upon reaching the age of 15, signs of appendicitis in children are identified by a dry coated tongue, nausea, and periodically opening vomiting. Adolescents complain of chills and weakness. When measuring temperature, it turns out to be slightly elevated. Pain in the abdomen is aching in nature. Tolerable discomfort is replaced by sharp attacks.

If girls are concerned about these symptoms, mothers should find out the date of the last menstruation. It is possible that the discomfort is related to imminent offensive next menstruation. But it is better to play it safe and call an ambulance to the house.

Ways to check for appendicitis

How to check for appendicitis in a small patient, regardless of his age category? First, the doctor performs palpation of the abdomen, i.e., feels it. The child at this time has sharp pain and the iliac zone is tense. Rectal examination by the digital method reveals the overhanging of the rectal wall and soreness of the viscera. The detection of compacted areas formed from cellular elements, blood and lymph makes it possible to differentiate inflammation of the appendix from other pathologies of the peritoneum.

Laboratory diagnosis of appendicitis involves the study of the patient's blood and urine:

1. Urine study. Indicators biological fluid rarely change in acute inflammation. An increase in the number of erythrocytes, protein and leukocytes requires a deep study of the material, since abnormal data may signal the progression of the pathology urinary tract or kidneys.
2. General blood analysis. If a small patient is really sick with appendicitis, the study will show leukocytosis. Normal value white blood cells - no more than 9.

How does appendicitis appear on ultrasound? When assessing the state of the abdominal cavity, the sonologist sees the accumulation of fluid and the expansion of the appendix in diameter. It grows by more than 6 mm.

Diagnostic laparoscopy for a child is done by making an incision in the abdominal wall and inserting a fiber optic tube with a video camera at the end into the cavity. During the procedure, the device records the condition of the appendix. If the suspicion of inflammation is confirmed, the doctor immediately removes the process. Children are referred for radiography and CT of the peritoneum according to indications.

How to help a child at home

If a child or teenager complains of discomfort in the right side that does not disappear long time, do not delay calling an ambulance at home. Before the doctor arrives, put the child to bed, organize a cool plentiful drink and apply a damp towel to the painful area. Remember when the patient ate the last time, ask about the nature of the pain, measure the temperature.

When appendicitis begins to hurt, the desire to relieve pain is natural for every parent. But it is not necessary to alleviate the condition with painkillers, as they make it difficult to diagnose. AT acute cases postponing surgery can be life-threatening.

Giving children a laxative to adjust bowel movements is also not recommended. The drugs of this group accelerate the rupture of the process. Warming problem area, as well as setting enemas, is unacceptable. Like laxatives, activities will cause the appendix to burst. The outflow of the contents of the appendix threatens with peritonitis, in other words, inflammation will spread throughout the peritoneum.

Treatment of appendicitis in children

Knowing how to determine appendicitis, the surgeon will quickly examine the patient's condition and proceed with the operation. There are no other methods of treating an inflamed process. In most cases, a specialist performs a laparoscopic appendectomy, which allows to reduce the time of postoperative recovery.

If the doctor prefers classic version surgery, the area of ​​the appendix from the side of the abdomen will be incised. Next, the process is excised, and the anterior abdominal wall- sutured. Immediately after the operation, the child should be in bed and not eat. But the next day, he is allowed to get up for a while, eat yogurt with crackers and drink low-fat kefir. Gradually, the diet expands, but any dishes after excision of the appendix are given to the child in a warm, diluted form. An important task of the postoperative period is the adjustment of a regular chair.

Appendicitis is an inflammation of the vermiform appendix of the caecum (appendix). This is one of the most striking diseases encountered in pediatric surgery.

In young children, it is manifested by a change in body temperature, abdominal pain, vomiting, nausea, diarrhea or constipation. Babies become lethargic, cry and act up. Treatment is carried out only with the help of surgery (appendectomy).

main feature pediatric appendicitis - very fast development disease(it can burst and there will be peritonitis), so after making a diagnosis, emergency surgery is required.

Which side is the appendix in children?

Usually, the appendix is ​​located in the right iliac region (in the lower part of the right half of the abdomen).

Important! Given these reasons, for the prevention of the disease it is necessary:

attack of appendicitis developing very rapidly. Therefore, destructive changes in the process appear rather quickly. In this regard, inflammation is often transferred to the peritoneum and a very life-threatening complication appears: appendicular peritonitis.

From simple catarrhal form appendicitis quickly becomes destructive (phlegmonous or gangrenous). If you do not resort to treatment in time and ignore the signs of the disease, it can lead to the following serious complications:

• Perforation of the process walls and peritonitis
• Periappendicular infiltrate (may become chronic)
• Intestinal obstruction
• General blood poisoning
• Appendicular abscess

Important! In time from the onset of inflammation to peritonitis, it can take from 24 to 36 hours.

Chronic appendicitis It is much less common in children than in adults. Usually, it manifests itself as a periodic occurrence of pain in the right lower side. Moreover, each such attack is accompanied by classic symptoms: nausea and fever.

The first signs of appendicitis in children

The beginning can be different. What exactly starts the attack, depends on the location of the appendix.

by the most early symptom considered pain in the navel. Then it moves and concentrates at the location of the process.

• With a classic arrangement: pain radiates to the lower right abdomen
• In the pelvic position: the suprapubic region becomes painful and appears frequent urination and diarrhea with mucus.
• For subhepatic location: pain is felt in the right hypochondrium
• With a retrocyclic (appendix is ​​located behind the rectum) location: back starts to hurt.

Another early sign- Refusal to eat.

In all cases of the disease, there is a symptom such as vomiting. Unlike conventional poisoning vomiting does not bring relief.

• Babies vomit multiple times
• For school-age children single or double

Temperature

Fever is also one of the most important signs.

• In young children temperature rises high up to 40°
• Aged 3 - 5 years the temperature rises to 38 - 39 °.
• For older students (12 years old and over) the attack is accompanied by subfebrile temperature indicators (up to 38 °).

Changes in stool are another of the main symptoms of appendicitis.

• Babies will have loose stools
• In children from 3 - 5 years there is a delay in stool (not constipation)
• In adolescents, as in adults, constipation is more common.

Regardless of age, the surgeon always pays attention to the condition of the tongue. On this basis, it is possible to determine at what stage, at this moment the disease is located.

• At the stage of simple or catarrhal appendicitis the tongue will be wet and covered with a white coating closer to the root
• In the destructive stages, in particular at the phlegmonous stage, the tongue will also be wet, but already completely coated
• At the gangrenous stage(most dangerous) tongue will be dry and completely white

This symptom should never be ignored, especially if the child is still small.

Up to three years, inflammation occurs suddenly and develops very rapidly, so at the slightest sign, you should immediately consult a doctor. If possible, the doctor's examination is best done in a dream.

Among the signs of appendicitis in babies, which should alert parents can be called:

• Lack of appetite
• Decreased activity
• Anxiety
• Poor sleep (especially the first night after the onset of an attack)
• Nausea and vomiting
• The temperature can rise up to 40° (if the child is breastfeeding, the temperature may not rise above 37.5 °)
• diarrhea or frequent stool
• Painful urination
• Increased heart rate
• The kid does not allow himself to be examined, and also bends and pulls his right leg towards him when squatting.
• The pain is aggravated when dressing or while bending to the right. It is painful for the baby to lie on the right side.
• Frequent loose stools, discharge may be with mucus. Especially if diarrheal appendicitis is present.

In addition to the fact that appendicitis can quickly turn from a simple stage into a destructive one and lead to complications, the danger of the disease also lies in the fact that frequent diarrhea can lead to dehydration.

It is necessary to call an ambulance when the child has the following symptoms:

• have a fever that is not related to a cold
• stomach ache for hours
• abdominal pain interferes with walking and is aggravated by coughing
• if the pain is relieved by pressure and worsened by releasing the hand

At the age of three to five years the child can point out where it hurts. This greatly simplifies the diagnostic process.

The peculiarity of this age is that the child can endure mild pain for some time and not tell his parents about it.

From the age of seven symptoms in childhood are the same as in adults. And yet, at this age, it is quite difficult to make a diagnosis, as he is frightened, often cries and is naughty.

At this age, because of the fear of surgery, children can say that nothing bothers them anymore and hide that the stomach continues to hurt.

In adolescents over 12 years of age the so-called symptom of "toxic scissors" is observed. This means that the pulse (100 - 120 beats per minute) and the body temperature, which is quite low for such indicators, do not correspond to each other. Only a qualified doctor can check this and other symptoms.

The table below provides information on the manifestations of the disease for the three main ages when there is a likelihood of appendicitis. In children under one year old, appendicitis practically does not occur, and in adolescents (from 11 to 18 years old), the symptoms are similar to the signs of the disease in adults.

Ages 14 to 19 inflammation of the appendix is ​​the most common. The symptoms are exactly the same

Girls besides general survey, give direction to the examination by a pediatric gynecologist. This helps to exclude pregnancy or diseases of the female genital organs.

Parents it is important to remember that before the arrival of the doctor when signs:

• You can not put a heating pad on your stomach
• Do not give painkillers (analgesics).
• Don't do an enema
• Can't give laxatives

Neglect of these tips is fraught with serious consequences.

Case of life. According to the stories of one patient, in childhood during an attack, she was given painkillers for two days. As a result, the girl lost consciousness, and an operation was performed with a diagnosis gangrenous appendicitis with peritonitis. After the operation, she was in intensive care for 4 days.

There are situations when a child's appendicitis was identified and excised after twelve hours in the clinic. Maybe, inflammatory process sluggish and does not manifest itself immediately. Even if after the arrival of the ambulance, appendicitis is ruled out, and the symptoms intensify, it is necessary to organize a repeated urgent mandatory visit to the clinic. This is confirmed by numerous case histories shared by parents on the forums.

Important! If you hesitate to visit the doctor and try to treat the disease at home on your own, it is dangerous for the child. Since appendicitis progresses much faster in children, there is a risk that if the diagnosis is delayed, a small patient may lose his life. Even if the doctors are not immediately sure about the diagnosis, it is better to leave the child in the clinic for a while for observation.

Diagnosis of appendicitis in children

At home parents can lightly feel the belly of a boy or girl. Palpation must be done very carefully. If the child is in pain right side, it is worth pressing a little with your fingers in this area, and some kind of seal may be felt. If you sharply remove your fingers and the pain intensifies, then an inflamed appendicitis is possible. If the pain gets worse when you cough, call an ambulance immediately!

To diagnose a problem, required medical examination. During the examination, the doctor determines by palpation whether there is muscle tension in the right side of the abdomen, checks the strength and localization of pain. During the examination, it is also seen whether there is irritation of the peritoneum.

If appendicitis is suspected, to clarify the diagnosis, in order to prevent peritonitis, it is necessary to do:

• Ultrasound examination (ultrasound). This method makes it possible to determine the presence or absence of acute inflammation with 95% accuracy.
• Complete blood count (allows you to determine the level of leukocytes)
• General urine analysis

If the above is not enough, and the clinical picture is unclear, you can also resort to:

• Computed tomography (CT)
• Do X-ray
• Laparoscopy (the method is used not so much to clarify the diagnosis, but to remove appendicitis)

Also used in chronic appendicitis the following types diagnostics:

• Endoscopic examination of the gastrointestinal tract
• Fecal analysis

Komarovsky about children's appendicitis

Treatment of appendicitis in children: surgery

Treatment is surgery to remove the appendix or appendectomy. Although there are extremely rare cases when a child recovers without surgery, most often it is necessary to resort to surgery.

• In children, appendectomy is best done using laparoscopic method. This is acceptable in cases where there is still no peritonitis. This operation takes only 20 minutes. To provide access, three small punctures are made. Through them, a small camera and the necessary tools are introduced.

How such an operation is performed on a child is shown in the video:

After laparoscopy, the child will have to stay in the hospital for about seven more days under the supervision of doctors.

• If happened rupture of the appendix, then the person is operated mainly through an open incision. During an appendectomy, in this case, damaged parts of the intestine are removed and the abdominal cavity is cleaned.

After such an operation, rehabilitation will last longer, and intensive care will be required. postoperative treatment antibiotics. Full recovery may take more than one month.

In children, the postoperative period is complicated by the fact that it is difficult for them not to eat or drink anything the first day after the operation. They cannot lie still and follow other recommendations of doctors.

Immediately after an appendectomy, one should expect the appearance of hematoma and edema in the suture area. After a few days, the swelling should start to decrease and the bruise will go away on its own.

During the rehabilitation period, the following are possible: unwanted complications:

• Delayed wound healing
• Suppuration of the sutures (often occurs due to the fact that pus was not completely removed after appendicitis with peritonitis)

If on the 6th - 9th day after the operation the temperature rises sharply, fever is observed and a sharp pain appears in the right side, then there is a risk of serious postoperative complications, such as:

• Purulent abscess
• Adhesive disease
• Internal bleeding
• Subdiaphragmatic abscess

Can a child under one year have appendicitis?

In one year old babies this disease is almost non-existent. Most often, this disease appears at the age of 6 years and older. According to the statistics of all cases of this disease in childhood:

• Toddlers account for only 5% of cases
• On the preschool age - 13%
• For school - 80%

In infants, the problem is extremely rare, since they have the lumen of the appendix is ​​wider, and the process itself is shorter in size. In addition, newborn babies have not yet fully developed lymphatic follicles. Moreover, the type of nutrition before 2 years of age is such that the likelihood of obstruction of the appendix is ​​very small.

Important! The symptoms of appendicitis are very similar to those of other diseases. Pain in the abdomen in a child can also be due to the presence of an infection in the body, as well as constipation, overeating, poisoning, and so on. To reveal exact reason pain, call the doctor.

Pain in the tummy in children can appear in different ages. Writing them down to malnutrition, overeating, gases and so on, we risk missing the terrible - inflammation of the appendix. A small outgrowth creates big problems up to the development of gangrene and lethal outcome. Read about how to identify and prevent them in time in the article "Signs of appendicitis in children."

By "appendicitis" is meant inflammation of the appendix. This is a process of the large intestine, with all its appearance resembling a worm. One of its ends is closed, the second it joins directly to the intestine. What role does it play and why is it present in the human body, scientists still have not been able to understand. They put forward different theories, according to which he is involved in the synthesis of substances that provide immunity, however, the amount of these substances for full-fledged work is still not enough.

Therefore, the first signs of inflammation of the appendix alert physicians and make them decide on surgical intervention. This, by the way, is not surprising. Judge for yourself: children's appendicitis is called the most terrible, simply because it is more difficult for children to diagnose. They have different symptoms due to the peculiarities of physiology at different ages.

But that's not all. Inflammation of the unfortunate process in childhood proceeds rapidly, so the risk of developing peritonitis in children increases significantly. What is peritonitis and how does it occur? If for some reason the open opening of the appendix becomes blocked ( fecal stones, foreign bodies, helminths, congenital pathologies of the structure of organs), mucus accumulates in the process, inflammation develops, which, in the event of a rupture of the walls of the appendix, risks breaking out into the peritoneum and provoking blood poisoning. Needless to say, in this case, the clock counts, and the result depends entirely on the professionalism of the doctors.

By the way, in infants, “acute appendicitis” can also be diagnosed, although very, very rarely. The risk of developing the disease increases by about 2 to 3 years. This age accounts for about 5% of cases. Preschool children are diagnosed with appendicitis in 18-20% of cases. Most often, children aged 7-14 years suffer, their statistics reach almost 80%. Adolescents and young people aged 15-19 are also at risk.

Symptoms in children of different ages

In infants terrible diagnosis practically never set. Doctors say that it's all about nutrition, as well as the size of the lumen (at this age it is very wide and it is almost impossible to clog it). If, nevertheless, a blockage occurs, then the baby becomes lethargic, passive to toys and food. To save himself from new pain, he lies on his left side, draws his legs, does not walk on his hands and pushes away everyone who tries to touch his tummy. The night passes restlessly.

Additionally, in 1-2 years, he may manifest:

• high temperature - 38 degrees and above;
• pallor of the skin;
• heart palpitations;
• diarrhea and vomiting (the frequency of the latter directly depends on age - the younger the baby, the more often vomiting).

In such conditions, dehydration also quickly sets in, and the danger increases many times.

At 3-4 years, it is even more difficult to diagnose the disease. There everything appears suddenly and proceeds with lightning speed. There is pain in the tummy, but children are not always able to clearly indicate it. They point to the navel, the entire tummy, aggravating the process of diagnosing.

In addition to the above symptoms, bloating, stool retention may be added. Peritonitis in such crumbs can develop within a few hours. But the worst thing is that, out of ignorance, parents blame everything on common problems with digestion and only miss time. There are also cases self-treatment. What is the result? In 25 - 50% of children, the tissues of the appendix rupture, as a result of which they are then treated for a long time in the hospital.

At 5-6 years old, many children are able to point to the location of the pain. First, it focuses around the navel, and then moves to the right iliac zone. If the process is located under the liver, it gives to the right hypochondrium, behind the caecum - to the lower back, in the pelvic area - above the pubis.

How to recognize the root cause? Follow the child. With appendicitis, his tummy hurts constantly, without interruption, which makes it difficult to sleep at night. The child refuses to eat. Once or twice he may vomit, sometimes he becomes constipated. The temperature sometimes remains normal, and sometimes rises slightly (up to 37.5 degrees).

At 7-8 years of age, a clearer clinical picture emerges, as in adults. Since morning in the right side the stomach hurts. There may be nausea, vomiting. When the pain intensifies, the child does not allow to the stomach. True, a similar picture is observed only in a third of small patients. In 70% of cases, the course is atypical: due to the location of the appendix, pain can occur in the lower abdomen, in the stomach, in the rectum, or even in the back.

At 9-10 years old with appendicitis:

• appear persistent nausea, vomit;
• sharp pain when pressing on the stomach;
• chills, temperature;
• appetite disappears, mouth dries up.

At 11-12 years of age, the symptoms in children are identical to those in adults. Meanwhile, the situation is aggravated by the still rapid course of the disease, as well as difficult diagnosis: parents confuse appendicitis with a disorder. The same is observed at 13 - 14 years.

In childhood, acute appendicitis is most often recorded, when inflammation develops rapidly. chronic stage children do not, meanwhile, at first, when the stomach only aches, they can ignore the pain and continue to attend school.

There are other symptoms of the disease:

• frequent urination - diagnosed with the pelvic location of the process;
• wet tongue, white coating at the root - with catarrhal (when inflammation is concentrated in the mucous membranes of the appendix);
• complete furnishing of the tongue - with phlegmous;
• dry tongue and white coating - with gangrenous.

The course of the disease may be completely asymptomatic. This happens with the gangrenous form, one of the most dangerous.

What to do and when to see a doctor immediately

Parents should be wary of the first signs of similarity with appendicitis. Pain in the tummy that does not go away within a few hours, as well as nausea, vomiting, is already a reason to see a doctor immediately. Remember that the characteristics of the course of appendicitis in children differ from the characteristics of the course in adults, besides, in the first case, lightning speed and swiftness are observed.

It is better to be safe, especially since most parents do this: of all cases of suspected inflammation of the appendix, the latter is diagnosed only in 10% of cases.

In order not to lubricate the clinical picture, you should:

• do not feed the baby;
• do not heat or cool the sore spot with heating pads and other things;
• do not give drugs - painkillers or laxatives;
• do not give a lot to drink, and with a strong thirst, just moisten the sponges with water;
• do not interfere with the child to take a comfortable position.

Never give an enema!

Diagnosis and treatment

How to determine the presence of inflammation of the appendix to a doctor? It turns out that for this in his arsenal there are different methods:

• palpation, or feeling of the abdomen;
• studying the results of a blood test and urine, feces, if necessary;
• analysis of the results of ultrasound, computed tomography, laparoscopy of the abdominal organs.

Teenage girls are prescribed a consultation with a pediatric gynecologist, as their symptoms resemble the eve of menstruation. In newborns, diagnosis is often made during sleep. At rectal examination the doctor identifies the location of the pain and notices the overhang of the anterior wall of the rectum.

The diagnosis is confirmed when an increase in the level of leukocytes is noticed in the blood test, and erythrocytes and protein are found in the urine. In babies, electromyography is sometimes used, fixing the tension of the muscles of the peritoneum. If it is difficult to make a diagnosis, a small patient may be advised to stay for 6 to 18 hours in a hospital.

Treatment involves removal of the appendix general anesthesia open or laparoscopic method. Everything about everything takes 30-60 minutes. The prognosis is favorable in most cases. The child after the operation, as a rule, feels well and is discharged already on the 6th - 8th day. After laparoscopic intervention, the patient recovers faster, as it is less traumatic and involves small incisions. With a destructive form of the disease, preparation is carried out before the operation: drugs are prescribed to relieve intoxication, antibiotics.

Note! In 15 - 20% of patients with perforated appendicitis (when the walls of the process were torn) and after surgical intervention There are complications: an abscess of the abdominal cavity. After the destructive form, adhesions may appear. Mortality in childhood appendicitis does not exceed 0.3%. Such good result- the merit of the surgeons who performed the operation in a timely manner.