The first signs of appendicitis in children 6 years old. Constipation or diarrhea. Treatment and consequences of acute appendicitis

Appendicitis in children is inflammatory disease appendix belonging to the caecum. Pathology occurs due to a weakened immune system, malnutrition, hypothermia or damage to the body by viruses. Its characteristic symptoms are directly related to the age of the child.

Up to 3 years, the lumen of the appendix remains very small, so children under 1 year of age rarely get sick with appendicitis.

From toddler age, the structure of the appendix gradually begins to approach the view of an adult. Acute appendicitis with minor clinical abnormalities manifests itself from the age of 7 to 12. B puberty the disease in a child proceeds as in an adult.

Forms of children's appendicitis

Signs of appendicitis in children are expressed depending on the form of the pathology. Acute inflammation surgeons are divided into several types:

1. Catarrhal, characterized by moderate inflammation and swelling of the mucous tissues of the peritoneum. This form is more common in medical practice, its symptoms are observed in 80% of patients of any age.
2. Phlegmonous. In this form, all layers of the appendix are involved in the process. Inside the process is filled with pus, small pustules jump up on the surface.
3. Gangrenous. At this stage, the walls of the appendix die off, and the tissues decompose.
4. Probodnaya. Worst case course of the disease, in which the appendix bursts.

Chronic appendicitis in children is rare.

Early symptoms of appendicitis

At the initial stage of the development of pathology, pain in a child occurs unexpectedly and is localized above the navel with a gradual downward displacement. sharp jolts and dull pain in the abdomen are early symptoms of inflammation of the appendix, but already require a visit to the clinic.

Then the picture changes. The pain becomes heterogeneous, spasms alternate with relaxation, aching pains, heaviness in the peritoneum. But the pain does not go away - it intensifies when walking, lying on your side and sitting. The child is overcome by weakness, nausea and vomiting.

Temperature indicators rise to 37 - 38 ° C. The specified range is included in the symptoms signaling a stable internal inflammation. Once the process reaches its peak, the temperature jumps to 39°C. There are no stool disorders in children with appendicitis. This allows the disease to be differentiated from gastric disorders, poisoning, etc. ailments that have similar symptoms.

Inflammation of the appendix in a child under 5 years old

In a 5-year-old child and younger, the following symptoms help to recognize the disease:

• The baby is pale and thirsty;
• He has chills and a slight rise in temperature;
• The baby suffers from constipation or “pouring” from it liquid stool;
• The kid is weakened, drowsy and capricious;
• Nausea is replaced by vomiting;
• Due to pain in the abdomen on the right, the baby tends to lie down on the right side and does not allow to feel the problem area.

Manifestations of appendicitis in children 6-14 years old

What symptoms accompany appendicitis in a student? Parents should be alerted by the lack of appetite and the child's complaints about constant nausea. Vomiting opens one-time or repeatedly. Chills occur, temperature fluctuations are observed. Acts of defecation pass without problems, but discomfort remain in the abdomen and resemble the pains of colic.

Symptoms of inflammation of the appendix up to 14 years of age completely coincide with the picture of the disease in adults. But the first subtle signs quickly reach severity, so it is important not to miss the beginning of the development of pathology.

How to recognize inflammation of the appendix from the age of 15

Upon reaching the age of 15, signs of appendicitis in children are identified by a dry coated tongue, nausea, and periodically opening vomiting. Adolescents complain of chills and weakness. When measuring temperature, it turns out to be slightly elevated. Pain in the abdomen is aching in nature. Tolerable discomfort is replaced by sharp attacks.

If girls are worried about these symptoms, mothers should find out the date last menstrual period. It is possible that the discomfort is related to imminent offensive next menstruation. But it is better to play it safe and call an ambulance to the house.

Ways to check for appendicitis

How to check for appendicitis in a small patient, regardless of his age category? First, the doctor performs palpation of the abdomen, i.e., feels it. The child at this time has sharp pain and the iliac zone is tense. Rectal examination finger way allows you to identify the overhang of the wall of the rectum and soreness of the viscera. Detection of compacted areas formed from cellular elements, blood and lymph, allows you to differentiate inflammation of the process from other pathologies of the peritoneum.

Laboratory diagnosis of appendicitis involves the study of the patient's blood and urine:

1. Urine study. Indicators biological fluid rarely change in acute inflammation. An increase in the number of erythrocytes, protein and leukocytes requires a deep study of the material, since abnormal data may signal the progression of the pathology urinary tract or kidneys.
2. General analysis blood. If a little patient really sick with appendicitis, the study will show leukocytosis. Normal value whites blood cells- no more than 9.

How does appendicitis appear on ultrasound? When assessing the state of the abdominal cavity, the sonologist sees the accumulation of fluid and the expansion of the appendix in diameter. It grows by more than 6 mm.

Diagnostic laparoscopy for a child is done by making an incision in the abdominal wall and inserting a fiber optic tube with a video camera at the end into the cavity. During the procedure, the device records the condition of the appendix. If the suspicion of inflammation is confirmed, the doctor immediately removes the process. Children are referred for radiography and CT of the peritoneum according to indications.

How to help a child at home

If a child or teenager complains of discomfort in the right side that does not disappear long time, do not delay calling an ambulance at home. Before the arrival of the doctor, put the child to bed, organize a cool, plentiful drink and apply a damp towel to the painful area. Remember when the patient ate the last time, ask about the nature of the pain, measure the temperature.

When appendicitis begins to hurt, the desire to relieve pain is natural for every parent. But it is not necessary to alleviate the condition with painkillers, as they make it difficult to diagnose. In acute cases, postponing surgery can be life-threatening.

Giving children a laxative to adjust bowel movements is also not recommended. The drugs of this group accelerate the rupture of the process. Warming problem area, as well as setting enemas, is unacceptable. Like laxatives, activities will cause the appendix to burst. The outflow of the contents of the appendix threatens with peritonitis, in other words, inflammation will spread throughout the peritoneum.

Treatment of appendicitis in children

Knowing how to determine appendicitis, the surgeon will quickly examine the patient's condition and proceed with the operation. There are no other methods of treating an inflamed process. In most cases, a specialist performs a laparoscopic appendectomy, which allows to reduce the time of postoperative recovery.

If the doctor prefers classic version surgery, the area of ​​the appendix from the side of the abdomen will be incised. Next, the process is excised, and the anterior abdominal wall- sutured. Immediately after the operation, the child should be in bed and not eat. But the next day, he is allowed to get up for a while, eat yogurt with crackers and drink low-fat kefir. Gradually, the diet expands, but any dishes after excision of the appendix are given to the child in a warm, diluted form. An important task of the postoperative period is the adjustment of a regular chair.

According to available statistics, many people (about 1 million people) have to deal with such a problem as appendicitis every year. It is important to note that most patients with this diagnosis are young children and adolescents. Currently, mortality due to appendicitis is negligible.

The appendix is ​​a small process (no more than 10 cm), which is located at the end of the so-called caecum. Outwardly, it resembles a worm; it does not play a special role in the process of digestion. That's what they thought a few decades ago. Previously, experts considered the appendix to be a useless process in the body and it was removed during any related operations. Today, doctors have a different opinion and, in the absence of an inflammatory process, they try not to remove it. The thing is that special protective cells were found in this process. In addition, it produces intestinal juice. It becomes clear that the appendix still plays some role in the process of digestion and protection of the body, although it is insignificant. In this article, we will talk in more detail about what this disease is, how to determine appendicitis in a child, and how this problem can be eliminated.

general information

Appendicitis is commonly understood as inflammation of the vermiform appendix directly to the caecum itself, which always requires surgical intervention. surgical intervention. Today, doctors immediately identify several reasons leading to the development of this problem. Note that without proper treatment it is almost impossible to solve it.

Many today believe that appendicitis in a child cannot occur. This statement is fundamentally wrong. After the first year of life, the risk of developing this problem increases steadily. The peak of the disease, according to experts, falls on the age of 9 to about 12 years. As already noted above, the only way The treatment for this disease is surgery.

If the diagnosis was made in a timely manner, and the doctors did everything to eliminate it necessary measures, then in this case appendicitis is not terrible. Optimal time for the operation from the moment of the onset of the attack is 6-18 hours. So, if for some reason this period of time was missed, the tissues in the appendix begin to gradually loosen. Then the pus is poured directly into the abdominal cavity, which already entails a more serious inflammation, namely peritonitis.

According to experts, this disease in infants is practically not diagnosed. However, from about three years old, the risk of developing the disease increases several times, and about 80% of all cases occur at the age of 9-10 years.

The signs of appendicitis in children are similar to the symptoms of this disease in adults, but there are still significant differences that are explained anatomical features young body.

Main reasons

Currently, experts put forward several assumptions that explain the mechanism of development of the inflammatory process in the process.

The above are only the main causes of appendicitis in children. In fact, experts today name other factors contributing to the development of this problem. For example, frequent stressful situations. There is an opinion that swipe in the stomach can also provoke this ailment. In this case, there is a rapid contraction blood vessels, which entails a sharp inflammation of the appendix.

Clinical forms of the disease

According to experts, the signs of appendicitis in children primarily depend on clinical form ailment. The inflammatory process can be of the following types:

• simple (uncomplicated) appendicitis;
• gangrenous appendicitis;
• phlegmous variant of the disease;
• complicated perforated appendicitis;

Symptoms of the disease in children under five years of age

1. Capriciousness and restlessness.
2. liquid and frequent stool.
3. Lack of appetite.
4. Painful urination(baby keeps crying).
5. Drowsiness and lethargy.
6. Vomit.
7. Temperature rise up to 40 degrees.
8. Pale skin.

It can be quite difficult to confirm appendicitis in a 3-year-old child only by external factors. clinical signs. The thing is that at this age the pain is not localized in any particular place. That is why it is so important to regularly monitor the condition of the baby, and if the above signs appear, immediately seek medical advice. qualified help.

Symptoms of the disease in children from 5 to 15 years

Appendicitis in a 10-year-old child primarily manifests itself in the form of pain in the abdomen. At the beginning of the disease, when the discomfort is not obvious, the child can go to school, play with other children and be active. Then the condition deteriorates sharply. The child literally in a few hours becomes drowsy, his body temperature quickly rises, he refuses to eat. Approximately six hours after the onset of discomfort appear typical signs appendicitis in children. This is nausea, and a yellowish coating on the tongue, and an upset stool, and severe pain in the navel area.

It also happens that the child literally suddenly falls ill. For example, in the morning he can wake up with severe pain in the right side of the abdomen and fever. By clicking on given area the child may even scream. All of these symptoms may be considered grounds for suspecting the presence of acute appendicitis. Note that in modern medicine there are two variants of the course of the disease: acute and chronic. The latter is characterized by some atrophic changes in the very wall of the appendix.

Acute appendicitis in children is dangerous because it literally “disguises” itself as other diseases, significantly complicating the final diagnosis. This is due to the fact that appendix often located in an atypical place (in the zone Bladder or near the liver). As a result, it completely changes clinical picture.

How to determine appendicitis in a child yourself?

Parents can identify the disease on their own, however, this does not mean that you should not seek qualified help.

First of all, you can ask the child to cough. If at the same time he feels discomfort in the right iliac region It's most likely appendicitis.

You can also ask the child to lie exactly on the right side and gently pull the legs to the body. In this case, the pain, as a rule, subsides, which is again characteristic of this disease.

Appendicitis in a 6-year-old child, for example, can be checked by gently pressing on the area where it hurts. If at the same time the discomfort weakens, you can safely call ambulance. As soon as you remove your hand from this place, the pain should reappear.

It is important to note that this kind of self-diagnosis is necessary only in order to urgently call a doctor, because the treatment of this disease is impossible without surgical intervention.

What can't be done?

Experts do not recommend giving painkillers, as they will only alleviate the condition for a while and at the same time distort the true situation, and the disease will go on as usual.

In addition, you should not put a heating pad on the abdomen. The thing is that heat only enhances the development of the inflammatory process.

Diagnostics

If a child has any of the above symptoms, it is essential to seek help from the appropriate doctor without delay. In no case should you self-medicate. The thing is that many painkillers only distort the primary clinical picture, subsequently significantly complicating the diagnosis.

To confirm appendicitis in a child, the doctor resorts to the following diagnostic measures:

• visual inspection + palpation, history taking;
• urinalysis + complete blood count;
• radiography of the abdominal organs;
• ultrasound procedure;

The signs of the disease in a teenage girl are similar to the symptoms of inflammation of the ovaries. In order to exclude this disease may need to be seen by a gynecologist.

Treatment

As noted above, appendicitis in a child is not amenable to drug treatment This is where surgery comes in handy.

The operation to eliminate this problem is being carried out today endoscopic method. So, instead of a long incision in the abdominal cavity, the specialist makes a small hole of about 5 mm. Through it, a special manipulator will subsequently be introduced, which is a replacement for the surgeon's hands. This operation is very easily tolerated, blood loss is minimal, and the surrounding tissues are not injured. Literally two hours after the appendectomy, the child can walk around the ward on his own, and after another two days, he is usually discharged.

The only indication when appendicitis in a child is subject to conservative treatment, is the so-called appendicular infiltrate (the appendix and adjacent organs are in a soldered state). In this case, the patient is given drug therapy. However, literally a month later, the doctor still prescribes a planned appendectomy.

Postoperative period

First of all, it is very important to limit excessive physical exercise(weight lifting, cycling or skiing, etc.). Still, the child must adhere active image life. Walking on fresh air, simple housework - all this is useful for the recovery of the body. Active exercises are allowed to be introduced gradually and only after consulting a doctor.

What should be the food?

It is very important to follow a fairly simple diet in the first weeks after surgery. There must be a certain drinking regimen(about two liters of non-carbonated water per day). On the fourth day, you can start giving the child steam cutlets. The diet should consist mainly of light meals and soups, liquid cereals. It is recommended to feed often (about six times a day), but in small portions. If a small small patient refuses food, it is not recommended to insist.

In the future, it is better to abandon all canned food, as well as those products that provoke increased gas formation in the intestines (legumes, cabbage, grapes, etc.).

Possible Complications

An untimely diagnosed appendicitis in a 4-year-old child (however, as in any other age) can lead to the development of complications, one of which is perforation. It usually ends with peritonitis.

Another consequence of this disease is intestinal obstruction. It appears if the inflammatory process has disrupted the usual work of the intestinal muscles.

Blood poisoning is also among the common complications after appendicitis. Once in the blood, bacteria gradually disrupt the normal functioning of all systems of internal organs.

Conclusion

In conclusion, it should be noted once again that this disease is not dangerous. Appendicitis in a 5-year-old child also responds well to treatment, as in an adult. In this case, it is important to diagnose inflammation in a timely manner and not postpone treatment, as they say, in a distant box. Operative surgical intervention allows you to forget about such an ailment forever. We hope that all the information presented in this article will be really useful for you.

Appendicitis is an inflammation of the appendix. This is the part of the large intestine, which is located in the lower abdomen on the right. This is his default location. It can also be localized in the liver, in the pelvis, or mirrored in the left side of the abdomen.

The appendix is ​​an atavism, that is, an organ that does not carry any functions, but its inflammation brings a lot of inconvenience and discomfort.

Most often, appendicitis develops in children from 9 years of age.

Causes of appendicitis in children

The causes of appendicitis in children is the overlap of the intestinal lumen, and the development of pathogenic flora. Several factors contribute to this.

Can block the lumen of the appendix foreign body. Most often, these are fruit or fish bones and also seeds. Another reason is worms and excessive growth of lymphoid tissue. Constipation can also contribute to inflammation. The reason for this is fecal stones, which accumulate in the process.

Obstruction of the appendix or its abnormal bends cause the accumulation and development of pathogens in it. They enter the process with blood often after suffering infectious disease while causing swelling.

Dysbacteriosis, overeating, consumption of large amounts of sweets can also cause appendicitis..

The first signs in children and adolescents

Appendicitis develops abruptly and can catch a child anywhere.

The first symptoms of the disease are:

• pain - pain sensations first appear in epigastric region. Then, as the disease progresses, they move lower. The final place of localization is the right side of the abdomen from below. At first, the pain is mild, insignificant. But due to the intensification of the inflammatory process, its intensity increases, and, in the end, it becomes unbearable;
• children are restless, crying, refusing to eat;
• when feeling the abdomen, there is a sharp pain. Children jerk away the hand of an adult who is trying to explore the abdominal wall, as this brings them discomfort. It is difficult for babies to squat, the position on the right side is painful;
• fever is not a pathognomonic symptom for appendicitis. It may not be at all, or, conversely, a fever of up to 40 ° develops.

When similar symptoms see a doctor. With the help of simple tests, he will be able to confirm or refute the diagnosis of acute appendicitis. Otherwise, if you ignore these signs, they can develop into serious complications.

Symptoms of appendicitis in children

Appendicitis is rare in children under 2 years of age.. This is due to the peculiarities of the nutrition of babies, as well as the fact that the amount of lymphoid tissue in the appendix is ​​insignificant. Clearance with which it communicates with other departments digestive tract, quite wide and difficult to overlap.

But unfortunately, Inflammation of the appendix can also happen in children infancy . In this case, the diagnosis of the disease is difficult. Symptoms of appendicitis in infants are manifested by a violation general condition baby. He becomes capricious, his appetite decreases, his favorite toys do not attract him, the child cries in his arms.

Vomiting appears, moreover, than younger child the more often it becomes. Diarrhea may also join. Vomiting and loose stools lead to dehydration of the child. He becomes pale, lethargic, breathing is rapid and shallow. The temperature can be raised to 38 ° or absent.

The complexity of the course of the disease lies in the fact that a small patient cannot tell that his stomach hurts.

Symptoms of appendicitis in children 2-3 years old similar to those of breasts. But at the same time, a small patient of this age may respond to painful palpation of the abdomen. Appendicitis in such children proceeds rapidly and develops into peritonitis at lightning speed. Symptoms of inflammation of the appendix at an early age also include vomiting, diarrhea with mucus, fever. The pain intensifies on the first night of the disease, so the children do not sleep well, screaming and tossing and turning.

Children 4-5 years old they can already tell that their stomach hurts. Of course, they still cannot indicate a clear localization, but they show the stomach in the navel. Children become lethargic, refuse to eat and play, squatting causes pain. Attracts attention forced position: they lie on their left side, pulling their legs to their stomach. It reduces muscle tension and hence pain. Vomiting, as well as diarrhea, may not be.

Appendicitis in children 6-7 years old easier to recognize. They can a little more accurately indicate the location of the concentration of pain, which is permanent, without paroxysmal contractions.

Little smarties can cheat. When they see a doctor, they can say that nothing hurts them, if only they were not taken to the hospital. Therefore, it is worth paying attention to the position of the child: it is difficult for him to unbend, he walks or lies crooked, cannot turn on his right side. It causes pain..

The first symptoms of inflammation of the appendix in children 8-9 years old may go unnoticed. The child may experience minor pain without paying attention to it. But only when it becomes unbearable, he will point to it, while the child can already clearly determine the place of pain. With a typical location of the process, the pain is concentrated on the right lower abdomen. If the appendix is ​​under the liver, then pain occurs in the right hypochondrium.

The presence of a process in the small pelvis causes pain in the lower abdomen, behind the caecum - lumbar pain, painful urination. The appearance of a symptom of scissors is characteristic: with normal or slightly elevated temperature significantly increased heart rate. Children complain of nausea. There may be occasional vomiting.

Starting from the age of 9, the critical age for the development of appendicitis begins.

The causes of inflammation in children 10-11 years old is a strong growth of lymphoid tissue in the appendix, which clogs it. It should be noted that children have more early age disease progression is faster: very little time passes from the onset of pain to peritonitis.

In older children disease progresses more slowly. For example, pain and other symptoms in appendicitis in adolescents 12-13 years old occur a few days before the onset of complications.

Symptoms and course of the disease in adolescents 14-15 years old, as well as 16-17 years old, proceed in the same way as in adults.

Kinds

The classification of appendicitis is quite simple. It is acute and chronic.

Symptoms of acute appendicitis develop rapidly against the background of complete well-being. The acute form is divided into:

• appendicular colic- inflammation is small, fades after a few hours;
• catarrhal appendicitis- usual acute inflammation appendix;
• phlegmonous- characterized purulent inflammation, the appearance of ulcers. May break;
• gangrenous- develops as a result of thrombosis of the vessels of the appendix. There is its atrophy and decomposition. The child's condition is serious.

The reason for the development chronic inflammation appendix is ​​a previously developed acute appendicitis that ended without surgical intervention.

Symptoms of chronic appendicitis in children- these are periodic, not pronounced pains in the abdomen on the right after exercise or malnutrition. They pass quickly. Nausea, bloating, and upset stool also occur. Periods of remission may be replaced by relapses. Symptoms of the disease are the same as in acute appendicitis.

Diagnosis of appendicitis

In the recognition of the disease, it plays a leading role in the symptoms of the disease.

The rise of the strong prolonged pain in the abdomen is a reason to see a doctor.

1. Inspection. There are several main symptoms that are a sign of appendicitis:
   • Shchetkin-Blumberg symptom- gently press on the area of ​​\u200b\u200bthe appendix on the abdominal wall and quickly tear off the hand. At positive reaction there is a sharp pain;
   • Rovsing's symptom- press on the lower abdomen on the left. Without removing the hand, the second jerkily presses the abdominal wall a little higher. The pain at the same time gives to the right iliac region;
   • symptom of the Resurrection- run a hand over a tight shirt along the abdomen. Pain, again, appear in the abdomen on the right.
2. Rectal examination.
3. Blood analysis reveals an increase in leukocytes, or rather neutrophils. Erythrocytes, leukocytes, protein appear in the urine.
4. ultrasound abdomen and pelvis, CT.
5. Laparoscopy.
6. For girls adolescence obligatory examination by a gynecologist.

Do not attempt to test these symptoms yourself unless you have the proper experience.

Treatment

If you suspect the development of appendicitis in a child, do not give him painkillers until he is examined by a doctor. The pain will subside, the baby will stop complaining about it, and the inflammation will progress. This will lead to lingering current disease and adverse outcomes.

Enemas, laxatives are also contraindicated. Do not apply a heating pad with either hot or cold water.

Do not delay your visit to the doctor. If your child does develop acute appendicitis, then the only treatment is surgery.

The fastest and least traumatic method is laparoscopy.. The surgeon makes several punctures, and with the help of an endoscope and a camera, removes the process. After such an operation, children quickly recover, after a week they are already discharged, of course, subject to the regimen and diet.

In a complicated form, apply open surgery . Before it, infusion and antibiotic therapy is carried out. After such an operation, the recovery period lasts a little longer.

Appendicitis can have complications. These include:

• peritonitis develops at a rupture of a shoot. The contents of the intestine spill into the abdominal cavity, causing further development infections. In children, there is an increase in body temperature, severe pain in the abdomen, intestinal gas. As the process intensifies, the pain disappears. There is a clouding of consciousness;
• appendicular abscesses, infiltrates, bleeding. Develop 5-7 days after surgery. Their manifestations are sharp pains and hyperthermia;
• sepsis- the infection enters the blood, there is a generalized inflammation of the whole organism;
• suppuration of the postoperative wound. In this case, antibiotic therapy is prescribed, the sutures are removed, the wound is treated and drainage is placed;
• intestinal obstruction .

There is no specific prevention for this disease. It is important to monitor the nutrition of the child. It should be balanced and contain enough fiber to prevent constipation. It is important to carry out the prevention and treatment of helminthiases, as well as infectious diseases.

Appendicitis is a disease of childhood. At timely handling with help, it is easily eliminated and the child quickly recovers.

With a negligent attitude to its symptoms, inflammation of the appendix can have serious consequences, delaying treatment and for a long time removing the child from active life.

Appendicitis is an inflammation of the vermiform appendix of the caecum (appendix). This is one of the most striking diseases encountered in pediatric surgery.

In young children, it is manifested by a change in body temperature, abdominal pain, vomiting, nausea, diarrhea or constipation. Babies become lethargic, cry and act up. Treatment is carried out only with the help of surgery (appendectomy).

main feature pediatric appendicitis - very fast development disease(it can burst and there will be peritonitis), so after making a diagnosis, emergency surgery is required.

Which side is the appendix in children?

Usually, the appendix is ​​located in the right iliac region (in the lower part of the right half of the abdomen).

Important! Given these reasons, for the prevention of the disease it is necessary:

attack of appendicitis developing very rapidly. Therefore, destructive changes in the process appear rather quickly. In this regard, inflammation is often transferred to the peritoneum and a very life-threatening complication appears: appendicular peritonitis.

From simple catarrhal form appendicitis quickly becomes destructive (phlegmonous or gangrenous). If you do not resort to treatment in time and ignore the signs of the disease, it can lead to the following serious complications:

• Perforation of the process walls and peritonitis
• Periappendicular infiltrate (may become chronic)
• Intestinal obstruction
• General blood poisoning
• Appendicular abscess

Important! In time from the onset of inflammation to peritonitis, it can take from 24 to 36 hours.

Chronic appendicitis found in childhood much less frequently than in adults. Usually, it manifests itself as a periodic occurrence of pain in the right lower side. Moreover, each such attack is accompanied by classic symptoms: nausea and fever.

The first signs of appendicitis in children

The beginning can be different. What exactly starts the attack, depends on the location of the appendix.

by the most early symptom considered pain in the navel. Then it moves and concentrates at the location of the process.

• With a classic arrangement: pain radiates to the lower right abdomen
• In the pelvic position: becomes painful suprapubic region and there is frequent urination, as well as diarrhea with mucus.
• For subhepatic location: pain is felt in the right hypochondrium
• With a retrocyclic (appendix is ​​located behind the rectum) location: back starts to hurt.

Another early sign- Refusal to eat.

In all cases of the disease, there is a symptom such as vomiting. Unlike conventional poisoning vomiting does not bring relief.

• Babies vomit multiple times
• For school-age children single or double

Temperature

Fever is also one of the most important signs.

• In young children temperature rises high up to 40°
• Aged 3 - 5 years the temperature rises to 38 - 39 °.
• For older students (12 years old and over) the attack is accompanied by subfebrile temperature indicators (up to 38 °).

Changes in stool are another of the main symptoms of appendicitis.

• Babies will have loose stools
• In children from 3 - 5 years there is a delay in stool (not constipation)
• In adolescents, as in adults, constipation is more common.

Regardless of age, the surgeon always pays attention to the condition of the tongue. On this basis, it is possible to determine at what stage, at this moment the disease is located.

• At the stage of simple or catarrhal appendicitis the tongue will be wet and covered with a white coating closer to the root
• In the destructive stages, in particular at the phlegmonous stage, the tongue will also be wet, but already completely coated
• At the gangrenous stage(most dangerous) tongue will be dry and completely white

This symptom should never be ignored, especially if the child is still small.

Up to three years, inflammation occurs suddenly and develops very rapidly, therefore, with the slightest sign you need to see a doctor urgently. If possible, the doctor's examination is best done in a dream.

Among the signs of appendicitis in babies, which should alert parents can be called:

• Lack of appetite
• Decreased activity
• Anxiety
• Poor sleep (especially the first night after the onset of an attack)
• Nausea and vomiting
• The temperature can rise up to 40° (if the child is breastfeeding, the temperature may not rise above 37.5 °)
• Diarrhea or frequent stools
• Painful urination
• Increased heart rate
• The kid does not allow himself to be examined, and also bends and pulls right leg towards you when squatting.
• The pain is aggravated when dressing or while bending to the right. It is painful for the baby to lie on the right side.
• Frequent loose stools, discharge may be with mucus. Especially if diarrheal appendicitis is present.

In addition to the fact that appendicitis can quickly turn from a simple stage into a destructive one and lead to complications, the danger of the disease also lies in the fact that frequent diarrhea can lead to dehydration.

It is necessary to call an ambulance when the child has the following symptoms:

• have a fever that is not related to a cold
• stomach ache for hours
• abdominal pain interferes with walking and is aggravated by coughing
• if the pain is relieved by pressure and worsened by releasing the hand

At the age of three to five years the child can point out where it hurts. This greatly simplifies the diagnostic process.

The peculiarity of this age is that the child can endure mild pain for some time and not tell his parents about it.

From the age of seven symptoms in childhood are the same as in adults. And yet, at this age, it is quite difficult to make a diagnosis, as he is frightened, often cries and is naughty.

At this age, because of the fear of surgery, children can say that nothing bothers them anymore and hide that the stomach continues to hurt.

In adolescents over 12 years of age the so-called symptom of "toxic scissors" is observed. This means that the pulse (100 - 120 beats per minute) and the body temperature, which is quite low for such indicators, do not correspond to each other. Only a qualified doctor can check this and other symptoms.

The table below provides information on the manifestations of the disease for the three main ages when there is a likelihood of appendicitis. In children under one year old, appendicitis practically does not occur, and in adolescents (from 11 to 18 years old), the symptoms are similar to the signs of the disease in adults.

Ages 14 to 19 inflammation of the appendix is ​​the most common. The symptoms are exactly the same

Girls besides general survey, give direction to the examination by a pediatric gynecologist. This helps to exclude pregnancy or diseases of the female genital organs.

Parents it is important to remember that before the arrival of the doctor when signs:

• You can not put a heating pad on your stomach
• Do not give painkillers (analgesics).
• Don't do an enema
• Can't give laxatives

Neglect of these tips is fraught with serious consequences.

A case from one's life. According to the stories of one patient, in childhood during an attack, she was given painkillers for two days. As a result, the girl lost consciousness, and an operation was performed with a diagnosis of gangrenous appendicitis with peritonitis. After the operation, she was in intensive care for 4 days.

There are situations when a child's appendicitis was identified and excised after twelve hours in the clinic. Perhaps the inflammatory process is sluggish and does not manifest itself immediately. Even if, after the arrival of the ambulance, appendicitis is excluded, and the symptoms intensify, it is necessary to organize a second urgent obligatory visit clinics. This is confirmed by numerous case histories shared by parents on the forums.

Important! If you hesitate to visit the doctor and try to treat the disease at home on your own, it is dangerous for the child. Since appendicitis progresses much faster in children, there is a risk that if the diagnosis is delayed, a small patient may lose his life. Even if the doctors are not immediately sure about the diagnosis, it is better to leave the child in the clinic for a while for observation.

Diagnosis of appendicitis in children

At home parents can lightly feel the belly of a boy or girl. Palpation must be done very carefully. If the child is in pain right side, it is worth pressing a little with your fingers in this area, and some kind of seal may be felt. If you sharply remove your fingers and the pain intensifies, then an inflamed appendicitis is possible. If the pain gets worse when you cough, call an ambulance immediately!

To diagnose a problem, needed mandatory inspection doctor. During the examination, the doctor determines by palpation whether there is muscle tension in the right side of the abdomen, checks the strength and localization of pain. During the examination, it is also seen whether there is irritation of the peritoneum.

If appendicitis is suspected, to clarify the diagnosis, in order to prevent peritonitis, it is necessary to do:

• Ultrasound examination (ultrasound). This method makes it possible to determine the presence or absence of acute inflammation with an accuracy of 95%.
• Complete blood count (allows you to determine the level of leukocytes)
• General urine analysis

If the above is not enough, and the clinical picture is unclear, you can also resort to:

• Computed tomography (CT)
• Do X-ray
• Laparoscopy (the method is used not so much to clarify the diagnosis, but to remove appendicitis)

In chronic appendicitis, the following types of diagnostics are also used:

• Endoscopic examination of the gastrointestinal tract
• Fecal analysis

Komarovsky about children's appendicitis

Treatment of appendicitis in children: surgery

Treatment is surgery to remove the appendix or appendectomy. Although there are extremely rare cases when a child recovers without surgery, most often it is necessary to resort to surgery.

• In children, appendectomy is best done using laparoscopic method. This is acceptable in cases where there is still no peritonitis. This operation takes only 20 minutes. To provide access, three small punctures are made. Through them, a small camera and the necessary tools are introduced.

How such an operation is performed on a child is shown in the video:

After laparoscopy, the child will have to stay in the hospital for about seven more days under the supervision of doctors.

• If happened rupture of the appendix, then the person is operated mainly through an open incision. During an appendectomy, in this case, damaged parts of the intestine are removed and the abdominal cavity is cleaned.

After such an operation, rehabilitation will last longer, and intensive care will be required. postoperative treatment antibiotics. Full recovery may take more than one month.

In children postoperative period is complicated by the fact that it is difficult for them not to eat or drink anything the first day after the operation. They cannot lie still and follow other recommendations of doctors.

Immediately after an appendectomy, one should expect the appearance of hematoma and edema in the suture area. After a few days, the swelling should start to decrease and the bruise will pass by itself.

During the rehabilitation period, the following are possible: unwanted complications:

• Delayed wound healing
• Suppuration of the sutures (often occurs due to the fact that pus was not completely removed after appendicitis with peritonitis)

If on the 6th - 9th day after the operation the temperature rises sharply, fever is observed and a sharp pain appears in the right side, then there is a risk of serious postoperative complications, such as:

• Purulent abscess
• Adhesive disease
• Internal bleeding
• Subdiaphragmatic abscess

Can a child under one year have appendicitis?

At one year old babies this disease is almost non-existent. Most often, this disease appears at the age of 6 years and older. According to the statistics of all cases of this disease in childhood:

• On the toddler age accounts for only 5% of cases
• On the preschool age - 13%
• For school - 80%

In infants, the problem is extremely rare, since they have the lumen of the appendix is ​​wider, and the process itself is shorter in size. In addition, newborn babies have not yet fully developed lymphatic follicles. Moreover, the type of nutrition before 2 years of age is such that the likelihood of obstruction of the appendix is ​​very small.

Important! The symptoms of appendicitis are very similar to those of other diseases. Pain in the abdomen in a child can also be due to the presence of an infection in the body, as well as constipation, overeating, poisoning, and so on. To reveal exact reason pain, call the doctor.

The inflammatory process in the terminal part of the caecum is called appendicitis. This disease occurs in people different ages. They can easily affect young children and teenagers. Without providing timely medical care this disease can be deadly or cause serious complications.

Causes and provoking factors

The causes of appendicitis can be completely different external factors. As a rule, inflammation occurs after hypothermia or a decrease in immunity. A child can also get this disease if he has chronic diseases digestive system.

Improper nutrition low-quality products can also easily cause an inflammatory process in the intestines. The intake of a large amount of crude fiber can provoke acute inflammation of the terminal part of the caecum, causing disease.

Most a rare cause appendicitis may be congenital pathologies intestines. In this case, the baby is already born with a modified intestine. This may be an individual shortening of the length, as well as multiple bends or kinks in the wall. In this case, it is also quite common when exposed to external factors appendicitis may develop.

Why is it important timely diagnosis appendicitis can be seen in the next video.

Kinds

Like any inflammatory disease, appendicitis can occur in several forms. If the disease occurs for the first time and proceeds with sufficiently pronounced clinical symptoms, then this form is called acute. If, after the treatment, in which the appendix was not removed, appendicitis occurs again, then this form of the disease is called chronic. It requires the removal of the appendix in order to prevent future dangerous symptoms.

All sharp forms diseases can be divided into several types:

• catarrhal form of the disease. In this case, the disease proceeds as calmly as possible and, as a rule, does not cause life-threatening complications. With this form, the inflammatory process captures the wall of the caecum and provokes the appearance of the first specific symptoms appendicitis. If a surgical operation was performed on time, the baby is completely cured.
• Phlegmonous form of the disease. Is already more dangerous, it can cause life-threatening complications. With this variant of the course of the disease, severe inflammation of the intestinal wall already occurs. Thrombosis of the vessels supplying the caecum is also possible.
• Gangrenous form. Most dangerous option the course of the disease. During inflammation in this course of the disease, the intestinal wall dies off. This option can cause life-threatening complications for the child: a breakthrough of the wall and the release of the entire contents of the intestine into the stomach (with the formation of peritonitis and shock). In this case, urgent surgical operation with the removal of the organ. Only this measure will help save the baby's life.

First signs

It is better for each mother to be familiar with the manifestations of this disease in order to easily recognize dangerous problem at home. Defining this disease is not always easy.

Often parents think that the appendix is ​​on the right side. However, this is not quite true. The appendix is ​​very mobile. Anatomically, it can be located not only on the right. In 20% of babies, it is on the left side. In every 9 out of 10 children, it can even be located near the navel.

The onset of the disease can be quite non-specific. In many babies, the onset of the disease proceeds under the guise of a common cold. In the first days, the body temperature rises to 37 degrees, weakness appears, less often chills. The child becomes lethargic, eats poorly, refuses to play. Habitual activities do not bring him any joy. The baby is drowsy, often lies, spares the tummy.

During the first two days, parents often cannot suspect appendicitis and begin to give the child drugs for fever, as with the flu or acute respiratory infections. However, despite the started treatment, the effect is not noticed. In the meantime, the child is getting worse. There are already more specific symptoms for this disease. Body temperature rises to 38-39 degrees. The child complains of abdominal pain.

In the first two days, the pain begins in the area near the navel. Then it gradually descends down to the groin or to the right half of the body. The pain increases significantly with a change in body position. The child may experience nausea or even vomiting. However, these are not mandatory symptoms characteristic of appendicitis.

It is important to note the nature of pain in appendicitis. It may be different. Some babies feel pain moderately, without sharp amplifications. Others are spasms. In this case, the pain first intensifies, then subsides a little. As a rule, in most cases, stool disorders do not occur. Only in babies with chronic diseases of the intestines or stomach can sometimes experience constipation or diarrhea, but these are non-specific signs of the disease.

Does it show up the same way?

In children of different ages, the course of the disease can vary significantly. According to the latest scientific studies, the peak incidence occurs at the age of 10 years, 12 years. In most cases, babies are not affected at all. this disease. Babies under 5 years of age also get sick relatively rarely.

According to statistical medical data, every fifth person with appendicitis is a child aged 6 or 7 years. More than half of all cases of inflammation of the appendix in children occur in primary and secondary school age. As a rule, these are children from seven to 14 years.

Since the body of a three-year-old baby is noticeably different, for example, from the body of a nine-year-old schoolboy, the course of the disease is also different.

Up to five years

For babies of this age, the gradual development of the disease is characteristic. Body temperature rises relatively low. Quite often, nausea or vomiting may occur. Children often become capricious, eat poorly, and are very restless.

Babies under three years of age often have thirst and all the symptoms of dehydration. Skin and lips become dry. The baby begins to spare the tummy, does not allow to examine or touch. Babies in the first two years of life can also often develop constipation or very loose, single stools.

Up to ten years

In children, body temperature rises to 37.5-38 degrees. In more severe variants of the disease - even up to 39 degrees. Toddlers often feel sick, while vomiting or stool disorders, as a rule, do not occur.

Characterized by severe pain in the abdomen. When viewed or trying to touch the tummy, it increases significantly. The child tries not to lie down on the damaged side, as this greatly increases the pain.

Teenagers over 12 years old

In many cases, appendicitis at this age follows almost the same scenarios as in adults. In the first couple of days they appear characteristic pains in the umbilical region with a gradual movement to the right half of the abdomen or groin. Often the body temperature rises to 37-37.5 degrees. The pain is often paroxysmal, without severe spasms.

Stool disturbances, nausea or vomiting are not typical. But quite often there are signs of dehydration. The child has reduced or practically no appetite, weakness appears.

All symptoms of the disease are nonspecific. Often it is quite difficult to determine appendicitis on your own. In this case, you should definitely seek professional medical advice from a pediatrician.

Diagnostics

The appearance of the first symptoms of the disease is not yet a 100% method of making a diagnosis. Only a doctor can confirm appendicitis. To do this, the doctor will first examine the baby, conduct all the special medical tests that allow you to confirm the disease with sufficient accuracy already at home.

For staging accurate diagnosis need to take the child to the hospital. AT without fail he will have several tests. Clinical Analysis blood will show whether there is inflammation, as well as the severity of the development of the disease.

In difficult cases, when the diagnosis of appendicitis is difficult to establish, doctors resort to additional methods diagnostics. First, the surgeon will look at the baby. Then the child may have an ultrasound examination of the abdominal organs. This test will show what condition the appendix is ​​in, whether there is inflammation.

Before performing surgery to remove the appendix, doctors will take blood from the baby for additional tests. This is necessary for future anesthesia and surgery.

Treatment Methods

Inflammation of the appendix is ​​a surgical disease. In most cases, when the diagnosis is confirmed, the inflamed organ must be surgically removed. Home mode in this case is extremely dangerous. Without the provision of timely qualified medical care, the baby may even die.

During your stay in the hospital, your baby will have all the necessary urgent diagnostic tests and tests. After confirming the diagnosis, an operation to remove the appendix will be performed in a fairly short time. Postponing the operation in many cases is very dangerous. This may lead to the development of peritonitis or septic shock at the baby.

Recovery after the operation usually lasts 10-14 days. At this time, the baby is assigned a special diet that spares the organs. gastrointestinal tract. Vitamin therapy will help to quickly restore the child's immunity. All physical activities (and even more so visiting sports sections) are allowed one month after the operation, not earlier. In this case, all physical activity should be introduced gradually. Lifting heavy objects over 5 kg is strictly prohibited (for three months).

Possible Complications

The most common complications of appendicitis include:

• development of peritonitis. If medical assistance was provided untimely or the disease proceeds in an aggressive and dangerous form, inflammation of the peritoneum may occur. This significantly worsens the prognosis and requires urgent surgical operation.
• Septic shock. In some cases, appendicitis can also be caused by bacteria or viruses. With reduced immunity, the child may develop shock. In this case, there is a sharp decrease arterial pressure and the pulse quickens. The baby may even lose consciousness. The development of shock is a life-threatening event.
• Breakthrough of the wall of the caecum. If the disease was suspected late (or a surgical operation was performed untimely), due to severe inflammation intestinal contents may spill into the abdominal cavity. This is a very dangerous condition that can cause peritonitis or septic shock in minutes.
• Shock (due to dehydration). With severe symptoms of intoxication appear severe symptoms dehydration. This leads to a large load on the heart and blood vessels. The baby may develop tachycardia or arrhythmia.

Complications of appendicitis can occur in almost any course of the disease. If the baby has chronic diseases, immunity is reduced, or he receives corticosteroid hormones, the risk of developing complications increases several times.

Nutrition principles

After surgery to remove the appendix while still in the hospital, the baby will be prescribed a special sparing diet. For the first few days, babies are allowed to eat only mashed and low-fat foods. All dishes are prepared in a gentle way. As a rule, the menu contains only cereals, grated slimy soups and steamed lean meat.

When discharged from the hospital, the attending surgeon gives recommendations to the mother about what the baby can eat after the operation. Therapeutic diet it is recommended to observe within one to two months. This will allow the inflamed intestinal wall to recover quickly, weak children's body strengthened.

Basic principles medical nutrition after surgery:

• Small portions of food. Babies should eat up to six times a day (in moderation). The volume and quantity of food is measured according to age tables. Overeating in the postoperative period is very dangerous! This can lead to re-inflammation of the intestines and provoke the appearance of complications.
• No very fatty, fried foods. All products containing smoked products or marinades are also excluded. All food should only be lightly salted. Spicy and overly bright seasonings are prohibited. In the first month, only a little can be added to food. table salt. From the fifth week after the operation, you can add a little black pepper. Sugar, vanilla or a little cinnamon can be added to sweet dishes.
• During the first two weeks after surgery fresh fruits and vegetables can be eaten only after heat treatment. Raw fruits with peel are strictly prohibited. Apples and pears are delicious after roasting with a little cinnamon or powdered sugar. Try to limit the high amount of crude fiber in your child's diet.
• Introduce fiber gradually. The basis of the diet in the first two weeks for the baby is well-boiled cereals, as well as meat products or a bird. You can use fish.
• Choose a gentle way of cooking. Leave frying and grilling until the baby is fully recovered. by the most the right way cooking will be boiling or cooking in a slow cooker, double boiler.
• As right carbs use well-boiled porridge. No more than 1-2 times a week, you can add a little pasta or noodles. In the first two weeks after surgery, prepare dairy-free cereals. The addition of dairy products can lead to a violation of the stool, to the appearance of diarrhea.
• Sufficient water intake. After severe dehydration, the child's body really needs water (to replenish lost reserves). Add fruit and berry fruit drinks, compotes, tea and plain boiled water to your child's diet.

Prevention

It is almost impossible to insure against the appearance of appendicitis. At any age, this disease can be taken by surprise. However, when executing following conditions You can slightly reduce the likelihood of appendicitis in your child:

Treatment of appendicitis should be timely and fast. Delay in providing medical care for this disease is unacceptable! Only an emergency surgical operation will help to cure the disease in time and save the life of your baby. You can suspect the disease yourself, but you should definitely call an ambulance or a pediatrician.

What may indicate abdominal pain in a child, see the following video.