#Changsha headlines##湖南光琇医院#
At 9 o'clock in the evening, a mother and her 8-year-old daughter hurriedly came to the ultrasound department of Hunan Guangxiu Hospital for treatment.
The mother said that since the morning, the child has had a slight abdominal pain around the navel, but she did not pay enough attention to it. Until nightfall, the child's abdominal pain worsened, and the location shifted from the previous periumbilical to the right lower abdomen, and he also developed fever and nausea.
After an ultrasound examination, the doctor diagnosed the little girl with appendicitis.
Appendicitis is a common disease in clinical practice, many adults have experienced it, but can children also get it?
The appendix is an elongated blind tube on the inside of the cecum, usually 7 to 9 cm long, located in the iliac fossa of the right lower abdomen. The proximal end of the appendix communicates with the cecum and ends in the blind end.
Appendicitis can be caused by the following causes:
1. Bacterial infection factors, direct intestinal invasion, hematogenous infection, adjacent infection;
In simple appendicitis, an increase in the outer diameter can be seen on ultrasound and abundant blood flow signals on the appendix wall.
In purulent appendicitis, swelling of the appendix and empyema in the cavity can be seen on ultrasound.
In purulent appendicitis, ultrasound may show thickened, continuous wall and pus in the cavity.
2. Decreased immunity and appendiceal ischemia, the most common situation is that after having appendicitis, if there is a decrease in immunity, such as fatigue, business trips, and high study pressure, there will be recurrence;
3. Combined with chronic fecal stone appendix lumen obstruction, as well as congenital distortion, stenosis, adhesions, etc., which cause appendiceal compression and distortion, the appendix lumen is often blocked, which will also lead to repeated appendicitis.
Ultrasound shows echo of fecal stones in the appendix space and peripheral lymphadenopathy.
Ultrasound may show fecal echo in the appendix cavity with acoustic shadows.
Adults and children, as long as they have an appendix, there is a possibility of appendicitis. Appendicitis in children begins at the age of five or six, with the peak at the age of ten. Parents need to be vigilant that appendicitis in children is likely to be missed or misdiagnosed because of atypical symptoms. In addition, the younger the child, the worse the resistance, and the inability to accurately say how he feels, the greater the risk of developing the disease.
Why does pediatric appendicitis progress faster?
The child's omentum is not well developed, the periphery of the appendix is loose, the inflammation is easy to spread, and the appendix wall is thinner than that of adults, the lumen is small, and the muscle tissue is less, and it is easy to perforate after inflammation.
Once perforated, it is easy to spread to form diffuse peritonitis, which can quickly develop into severe infection, sepsis, septic shock and even death in severe cases.
Watch for these symptoms in your child:
- Abdominal pain, metastatic right lower quadrant pain in adults or older children, and periumbilical pain with vomiting and fever in younger children.
- When appendicitis attacks, your child prefers to lie on his right side with his legs slightly driven. At this time, if the left side is decubitus, the appendix and cecum will be stretched, aggravating the pain.
- When touching your child's abdomen, he will have a painful expression, when he touches his right lower abdomen, he will cry out in pain or even refuse to touch it, and when he touches it after falling asleep, he will wake up.
- Unsteady gait and limp in the right leg when walking.
- Infants and young children generally present atypically, and when the child has abdominal pain, it is necessary to see a doctor in time, and surgery should be performed in time after diagnosis
The ultrasound department of Hunan Guangxiu Hospital reminds parents:
The symptoms of appendicitis in children are atypical, and the perforation rate is high, so it is necessary to diagnose, treat and operate in time.
Ultrasound is the most appropriate diagnostic tool, CT/MRI can be used as a supplemental test, and CT is not recommended as a routine test in children with right lower quadrant pain.
Bibliography:
Practical pediatric abdominal ultrasound diagnostics
Pediatric diagnostic ultrasound
Chin J Practical Surg 2020, 40(11): 1331-1335
WSES Guidelines for the Diagnosis and Treatment of Emergency Appendicitis 2020 Edition
Hunan Medical Chat Special Author: Wang Lin, Department of Ultrasound, Hunan Guangxiu Hospital
Follow @Hunan Medical Chat to get more health science information!
(Editor YH)