[Current diagnostic-therapeutic trends in treatment of pediatric appendicitis].
Acute appendicitis is the first cause of emergency surgery in children. Actually, emergency abdominal sonography has evolved in differential diagnosis of acute appendicitis in children to differentiate it from other causes of acute abdomen as mesenteric lymphoadenitis, acute right pyelonephritis, acute diverticulitis in Meckel's diverticulum, intestinal intussusception, regional enterits, primary peritonitis, anaphylactoid purpura of Henoch-Schonlein. The aim of this study is the evaluation of the usefulness of abdominal sonography in diagnosing acute appendicitis in our current series of pediatric patients. We have operated 102 patients afflicted by appendicitis admitted to the pediatric department of Ospedale San Raffaele, Milano in a period of 5 years and operated on for appendectomy. In the last 2 years 36 patients were evaluated with abdominal sonography. This diagnostic tool showed in 34 (94.4%) a liquid effusion, sometimes thick of the right iliac fossa. In 2 patients the appendix had thickened layers, was edematous and the lumen was clearly filled with debris. Abdominal sonography has given a clear cut picture of the acute inflammatory process of the appendix. None of these patients has suffered from septic or obstructive complications. Mean duration of hospital stay was 6.35 days (3-15 days). Differential diagnosis of acute appendicitis can be extremely variable, from simple, paradigmatic situations to the most intriguing ones. This concept is well emphasized by William Silen when he says that "differential diagnosis of acute appendicits is an encyclopedic compendium of every abdominal disease that causes pain" in the 11th edition of Harrison's Principles of Internal Medicine.(ABSTRACT TRUNCATED AT 250 WORDS)
Divisione di Chirurgia I, Istituto di Ricerca e Cura a Carattere Scientifico, Ospedale San Raffaele, Milano.
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D000005:Abdomen / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000175:diagnosis; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D014463:Ultrasonography
D000900:Anti-Bacterial Agents
Attuali atteggiamenti diagnostici-terapeutici nel trattamento della appendicite in età infantile.