Often in everyday life we confuse the terms “appendix” and “appendicitis.” In fact, the difference is simple to remember: the appendix is an organ, the vermiform appendix of the cecum, and appendicitis is an acute disease of the appendix that requires surgical intervention.
Contrary to popular belief, the appendix is not an absolutely useless vestigial organ. Doctors often call the vermiform process of the “inner tonsil of the abdomen”: as the tonsils protect the lungs, the appendix protects the intestines, it concentrates lymphoid tissue, which takes part in various immune processes.
That is why in modern medicine they have abandoned the practice of removing the appendix for “preventive” purposes, since this is a direct intervention in the immune system. If a worm-shaped process is removed to a child against the background of complete health (as it was at one time it was customary to do, for example, in the USA), his body will be worse resistant to infections.
In the case when the appendix is inflamed (appendicitis begins), doctors are forced to remove it. Then other organs and tissues (lymph nodes, spleen, liver) will take over the immune functions of the removed organ.
The mechanism of development of appendicitis is well known. Normally, food moving through the gastrointestinal tract should not fall into the appendix. If the route changes, the “lost” parts will no longer be able to leave this organ on their own, decomposing in it, causing inflammation.
At first it flows only in the process, but after 12 hours it can spread to the entire abdominal cavity. Gases and mucus, formed by the decay of digested food, overwhelm the appendix, tearing its walls, the toxic content spreads, poisoning the body.
60-80-ies of the last century, it was believed that appendicitis provoke foreign bodies into the mouth, and from it into the stomach and intestines of the infant. Later, the hypothesis was refuted, but this does not mean that the crumbs can be “pulled” into the mouth all in a row.
Today, experts determine the cause of appendicitis as a coincidence of several adverse factors, in particular:
- overfeeding the child;
- fiber deficiency in the crumbs menu;
- excess carbohydrates – baking and sweets;
- gastrointestinal tract diseases (dysbacteriosis, gastroenteritis, ascariasis).
The occurrence of appendicitis in children is also affected by:
- Heredity. If the mother or father was operated, then the child may also develop appendicitis, and it is not uncommon for this to happen at the same age as the parents.
- Seasonality. The off-season (spring, autumn, thaw in winter), when the weather is constantly changing, atmospheric pressure is the peak of cases of acute appendicitis; Communication to specialists is still unclear, but in practice it is;
- Infections. The trigger of appendicitis can be a common “cold” (upper respiratory tract infection, sore throat, otitis media, etc.).
Appendicitis can be acute and chronic. In the first case, the attack begins suddenly and develops very quickly.
In the second – a baby for several weeks or even months complains of discomfort and pain in the tummy. But this form of the disease is more common in adults.
Surgeons allocate four forms or stages of appendicitis.
- At the initial – simple or catarrhal – appendix slightly thickened wall.
- In the next, destructive phlegmonous, the organ is already increasing in size, the blood circulating through it and nearby vessels becomes thicker, and blood clots form in it.
- Then the disease progresses and goes into a destructive gangrenous phase – the tissues forming the appendix walls die off (necrosis).
- The most dangerous stage is perforation or rupture of the appendix and release of its contents into the abdominal cavity. At this stage, appendicitis is complicated by peritonitis – inflammation of the peritoneum, which is accompanied by poisoning of the body and disruption of the work of many organs and systems.
The stage of appendicitis is indicated, in particular, by the state of the tongue, more precisely, the white plaque on it. The stronger the inflammation, the greater the area it covers: with the catarrhal form, only the root is coated, with more complex the entire tongue.
Most often appendicitis occurs in people aged 10-30 years. At the age of 1−1.5 years, there are isolated cases. In children aged 2 to 7 years, the incidence is 3-5%.
Despite the fact that small children do not have appendicitis so often, the problem is that the younger the child, the more difficult it is to give him the correct diagnosis.
Doctors call appendicitis “abdominal chameleon” – it can hide under the mask of many other diseases. Most often untimely treatment of parents to the doctor and diagnostic errors occur in cases where appendicitis develops against the background of viral infections, after food errors.
Parents may think that the child’s stomach hurts because he has a cold or overeating (for example, in the summer after a hearty feast with barbecue and sweets), and wait until “everything will pass by itself”, while pain may actually be a sign of developing appendicitis .
The most important sign of appendicitis in children is an abdominal pain. It is permanent: it may increase or weaken, but it never passes to the end.
1) Abdominal pain. In the case of appendicitis, this symptom is always present. In the classical form, pain in appendicitis should appear in the right side, under the liver, where the appendix is located.
But not everything is so simple: the organs and parts of the baby’s body are small, so the worm-shaped process does not immediately take its “legitimate” place and can be shifted to the side – closer to the left and right hypochondrium, to the pelvis, etc. In this case It seems to the child that the whole tummy hurts, and even the loins. The baby will begin to protect this part of the body, not allowing anyone to touch it, it will move less, mostly lying on its back or right side, with its legs tucked in.
Symptom increases with walking, coughing, changing body position. If you take the child in your arms, he will cry.
If the child can already talk and understands so much in her body that she can indicate a diseased area, then with prolonged pain, you should periodically re-ask him where it hurts: a bright symptom of appendicitis will be a gradual shift of pain to the right.
The pain of appendicitis in a child is not like spasms or colic (spasmodic pain: the child suddenly complains of a stomach, cries; if very small – she has little legs, and after a while oars again – the colic has passed). When appendicitis pain is permanent (it can go “waves” – then amplify, then slightly subside, but not for a minute passes to the end).
It is important to remember that the intensity of pain does not indicate the level of danger – it may not be very strong, the main criterion is constancy.
2) Drowsiness, fever – in about 90% of cases, appendicitis in children is accompanied by a rise in body temperature (37–38 degrees), with the rapid development of the disease and the presence of complications (peritonitis) the temperature can reach 40 °.
3) Refusal to eat, nausea, vomiting (or diarrhea) are quite frequent, but not mandatory, symptoms of appendicitis in a child: vomiting occurs in about 70% of cases, usually once or twice, and 1-2 times the liquefied stools can occur.
4) Rapid deterioration. With the progression of purulent processes in the appendix, the child’s condition can quickly deteriorate: there is thirst, the color of the skin changes (pallor). The most dangerous complication of appendicitis is peritonitis – inflammation of the abdominal cavity, which is accompanied by severe pain.
What should be remembered by parents of a child with suspected appendicitis:
- Appendicitis in a child can develop rapidly. The sooner the child is examined by a doctor and the correct diagnosis is made, the more favorable the prognosis. Therefore, the most important thing for parents to remember is that if the pain in the abdominal cavity continues for 3–4 hours, you should definitely call an ambulance.
- Appendicitis in a child often proceeds uncharacteristically: the temperature is low or not at all, the pain is weak, lasts several days in a row. But in this case, all the doctors insist that it is better to play it safe, spend several hours in the emergency room to make sure that there is no appendicitis, than to seek help too late, when complications can no longer be avoided.
If you suspect appendicitis in a child should:
- If anxious symptoms appear, watch the baby.
- It is necessary to call an ambulance if pains in the abdomen persist for 3-4 hours (especially if they gradually move to the right), the temperature rises, the child refuses to eat, nausea and vomiting appear.
- Put the baby to bed before the doctor arrives.
- If you have vomiting or diarrhea, give the baby water in small portions to avoid dehydration.
- If the pain is not strong and is not localized on the right side, an antispasmodic can be given (if it is a spasm, it will pass, if appendicitis, then the antispasmodic will not help); if you suspect that your child may have constipation, make microcephalus a hypertonic solution (for a glass of cold water 1 tsp. salt; 100-150 ml of this solution will suffice for a 5- or 7-year-old child).
If you suspect appendicitis in a child can not:
- To warm the abdomen (this can provoke an appendix rupture and the occurrence of peritonitis).
- Giving the child painkillers (analgesics), it can lubricate the symptoms and interfere with the correct diagnosis.
Treatment of appendicitis in children: surgery and the postoperative period
In the case when there is a clinical picture of acute appendicitis, the only method of treatment is the removal of the appendix – an appendectomy is done. To begin, the surgeon chooses which of the operations is more suitable.
There are two options: if the inflammation is under control, then laparoscopic surgery is performed. In the abdominal cavity through small incisions – usually three are made – a video camera and tools are introduced in which they perform the necessary manipulations. Read more