Hamid Kewan A, Mohamed Mohamed A, Salih Anas
Department of Combined Internal Medicine-Pediatrics, Hurley Medical Center, Michigan State University College of Human Medicine.
Michigan State University College of Human Medicine.
Cureus. 2018 Mar 19;10(3):e2347. doi: 10.7759/cureus.2347.
Acute appendicitis is a grave and life-threatening condition in children, accounting for one to two cases per 10,000 in children less than four years' old. Prompt diagnosis and management are imperative to prevent serious complications, such as abscess formation, perforation, bowel obstruction, peritonitis, and sepsis. In young children, however, the diagnosis of this condition is challenging. The delayed utilization of imaging may further delay the diagnosis due to concerns of exposure to ionizing radiation. Even with a prompt diagnosis, controversy persists regarding medical versus operative management in these young patients. We report a case of a 21-month-old female who presented with fever, non-bilious, non-bloody emesis, and decreased tolerance for liquids and solids. The initial physical exam and imaging were suggestive of non-obstructive bowel distention. The patient was admitted to the pediatric floor. Overnight, the patient's condition deteriorated severely and became septic. Repeat imaging revealed a 9-cm appendicular mass and a ruptured appendix. Antibiotic coverage was then broadened and the patient was transferred to the critical care unit for more intensive management. The patient's septic condition improved over the upcoming few days and the parents elected to perform an elective appendectomy following resolution of the condition. Atypical presentations are common in this population. The difficulty in obtaining a reliable history and physical examination findings makes the diagnosis even more challenging. Moreover, concerns with radiation exposure may delay the diagnosis and increase the risk of perforation and peritonitis. Thus, clinicians should have a high index of suspicion for acute appendicitis, particularly in young children, as this condition is commonly missed on initial presentation.
急性阑尾炎在儿童中是一种严重且危及生命的疾病，在4岁以下儿童中每10000例中有1至2例。及时诊断和治疗对于预防严重并发症至关重要，如脓肿形成、穿孔、肠梗阻、腹膜炎和败血症。然而，对于年幼儿童来说，这种疾病的诊断具有挑战性。由于担心暴露于电离辐射，延迟使用影像学检查可能会进一步延迟诊断。即使及时诊断，对于这些年幼患者的药物治疗与手术治疗仍存在争议。我们报告一例21个月大的女性患者，她出现发热、非胆汁性、非血性呕吐，对液体和固体的耐受性下降。最初的体格检查和影像学检查提示非梗阻性肠扩张。患者被收入儿科病房。一夜之间，患者病情严重恶化并出现败血症。重复影像学检查发现一个9厘米的阑尾肿块和阑尾破裂。随后扩大抗生素覆盖范围，患者被转至重症监护病房进行更强化的治疗。在接下来的几天里，患者的败血症病情有所改善，病情缓解后，家长选择进行择期阑尾切除术。非典型表现在这一人群中很常见。获取可靠病史和体格检查结果的困难使得诊断更具挑战性。此外，对辐射暴露的担忧可能会延迟诊断并增加穿孔和腹膜炎的风险。因此，临床医生对急性阑尾炎应保持高度怀疑，尤其是在年幼儿童中，因为这种疾病在初次就诊时通常会被漏诊。
