Alloo Javed, Gerstle Theodore, Shilyansky Joel, Ein Sigmund H
The Family Practice Teaching Unit, The Scarborough Hospital, Toronto, Ontario, Canada.
Pediatr Surg Int. 2004 Jan;19(12):777-9. doi: 10.1007/s00383-002-0775-6. Epub 2004 Jan 16.
Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 degrees C or more (21), abdominal distension (18), Leukocytosis (<12.0 x 10(3)/mm(3)) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3-5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.
阑尾炎是儿科人群中最常见的外科腹部急症，但3岁以下儿童很少被考虑患有此病。本研究的目的是确定该年龄组的症状和体征，并检查其后续治疗及结果。回顾了一位儿科外科医生28年学术实践经验；27名3岁以下儿童（平均23个月）占其系列中所有阑尾炎患儿的2.3%。最常见的症状是呕吐（27例）、发热（23例）、疼痛（21例）、厌食（15例）和腹泻（11例）。症状平均持续时间为3天，9名儿童症状持续4天或更长时间。18名儿童在正确诊断前看过医生；14名最初被诊断为上呼吸道感染、中耳炎或尿路感染进行治疗。最常见的体征是腹部压痛（27例）、腹膜炎（24例）、体温38.0℃或更高（21例）、腹胀（18例）；18例白细胞增多（<12.0×10³/mm³），14例压痛局限于右下腹（RLQ），10例压痛弥漫。21例患者中14例腹部X线片显示小肠梗阻（SBO）表现，2例显示粪石，1例显示气腹。6名儿童进行了钡剂灌肠，其中5例有蜂窝织炎或脓肿。27例患者均发现穿孔性阑尾炎。25例行阑尾切除术，18例行右下腹引流。17名儿童术后使用抗生素，平均使用6天。2例患者进行了间隔期阑尾切除术，1例在静脉注射抗生素治疗后进行，1例在手术引流后进行。恢复经口进食的平均时间为7天，平均住院时间为21天（中位数15天）。16例患者出现22种并发症，包括6例伤口感染、4例脓肿、4例伤口裂开、3例肺炎、2例SBO、2例切口疝和1例肠皮肤瘘。所有3岁以下儿童均发现穿孔性阑尾炎，导致发病率非常高（59%出现并发症），这可能归因于诊断延迟3至5天。尽管阑尾炎在这个年龄组并不常见，但对于出现腹痛、压痛和呕吐三联征的3岁以下儿童进行鉴别诊断时，应认真考虑此病。
