Appendicitis in children

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Philippe Gloaguen
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Appendicitis is an inflammation of the appendix, a small protrusion of the intestine found on the right side of the belly. In the early stages, it causes vague pain around the navel, which can intensify and localize within a few hours in the lower right abdomen. In most cases it is resolved by removing the appendix with a small operation. interviewed Arrigo Barabino, head of pediatric gastroenterology at the Gaslini Hospital in Genoa, on the subject.

What is appendicitis?

Appendicitis or appendicopathy is inflammation of the appendix, a natural protrusion of the intestine in the shape of a long and narrow worm, located at the beginning of the colon, at the level of the cecum. "Its exact function is not yet clear, but recent research indicates that the appendix has the task of keeping a reserve microflora: that is, it would act as a shelter for beneficial bacteria, to be used to restore the intestinal microbial flora in case of need. , that is, after alterations of the flora due to intestinal infections ”underlines Barabino.

Why does appendicitis come?

Appendicitis occurs when the appendix becomes infected and then becomes inflamed. And this can happen if, for example, it is blocked by very hard pieces of stool (coprolites) or because the lymphatic tissue contained in its wall becomes so bulky that it plugs the internal cavity, blocking the normal drainage of intestinal secretions.

What are the symptoms of appendicitis?

Appendicitis can have different levels of severity and different symptoms depending on whether it involves only the appendix or extends outside, that is, towards the peritoneum.

Acute appendicitis: abdominal pain from periumbilical to lower right. When the inflammation remains limited within the appendix wall it is defined, based on the severity of the inflammation, acute catarrhal or phlegmonous appendicitis. In this case, the child may initially complain of a vague pain in the belly, mostly periumbilical, which quickly moves down and to the right; nausea, vomiting and fever may be associated.

Peritoneal inflammation: intense and localized pain in the lower right. If, on the other hand, the infection escapes from the walls of the appendix affecting the peritoneum - which is the serous envelope that envelops the entire intestine from the outside - it can give rise to peritoneal inflammation with sac-like effusions, i.e. the inflammation has come out of the peritoneum but is still confined to a specific pocket around the appendix.

In this phase the pain becomes more and more intense and localized in the lower right area of ​​the abdomen, more or less in the middle of the line that goes from the navel to the superior iliac crest (the widest bone in the pelvis). In addition, flank pain can radiate to the right thigh or liver, depending on where the inflammation spreads. Vomiting appears and, subsequently, fever.

Pertitonitis or perforated appendicitis: unbearable pain and general malaise. Peritonitis or perforated appendicitis occurs when the perforation of the appendix occurs and the pus does not remain confined in sacs but spreads into the peritoneum, causing diffuse peritonitis. The child has a state of general malaise and a greyish complexion; the belly is hard, tight and very sore. Vomiting and fever are always associated.

How is appendicitis diagnosed?

If you suspect that your baby has appendicitis, you need to take him to the pediatrician or to the emergency room. Already with the simple palpation of the abdomen, the doctor assesses whether it may be appendicitis: if the stomach ache is due to other causes, for example an irritable bowel, the doctor can easily palpate and push with the hand on the abdomen. , while in the case of appendicitis the touch of the doctor causes a lot of pain and resistance on the part of the child.

Most of the time, a medical visit alone is enough to make the diagnosis. If in doubt, an ultrasound is also done to see the thickening of the appendix wall, plus a blood test, which measures white blood cells and Reactive Protein C, values ​​which increase if there is inflammation.

Treatment: if in doubt, antibiotics can be tried

If the symptoms are not very evident and there is a doubt that it is not an appendicitis but an intestinal infection, try to prescribe an antibiotic therapy in the first instance.

If the diagnosis is certain, appendicitis is removed with surgery.

If, on the other hand, the diagnosis of appendicitis is clear, it is preferable to eliminate the appendix immediately even if it is an appendicitis in the early stages, because antibiotic therapy may not completely eradicate the infection and there may be a rapid relapse of the inflammatory process. appendicular after discontinuation of therapy.

The operation is simple, but, being children, it is always done under general anesthesia. “The intervention can be the classic surgical one, or, for some years, it has been done more and more often in laparoscopy, that is, by making small holes in the belly where endoscopic instruments are introduced that are able to extract the appendix” explains Arrigo Barabino.

The post-operative recovery is very rapid: in most cases, within 24-48 hours at the latest, the child can resume eating and go home, unless there have been abscesses that require pus drainage and targeted antibiotic therapy. .

Are there children predisposed to appendicitis?

Appendicitis is one of the main reasons for resorting to surgery in children. Because? Is there any way to prevent it? "There is no precise reason why appendicitis occurs, nor are there any incorrect habits or lifestyles that predispose to inflammation, such as constipation," replies the pediatrician. “What we find is that it occurs more frequently in the age group from 2 to 14 years.

  • On the other hand, it is very rare in the first 2 years of life, when however, if it occurs, it has a much more rapid and serious course since the organism's response to the infection is less effective ".
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