Symptoms of how appendicitis manifests itself in children of different ages. The main signs of inflammation of appendicitis in children and adolescents Whether a child has appendicitis

Inflammation of the appendix, or appendicitis, is a common pathology of the appendix of the caecum. It is easy to diagnose in medical institution with the help of special equipment, but ordinary parents at home need to know not only the general signs of inflammation, but also the physiology, etiology, types of complications, diagnostic techniques, and, most importantly, the algorithm of actions for suspected appendicitis.

Most of the symptoms that are characteristic of appendicitis can easily be attributed to a number of other childhood ailments. But most of them, such as: gastritis, food poisoning, otitis media, SARS, parents prefer to treat on their own.

Meanwhile, acute appendicitis in children develops one and a half times faster than in adults, and delay is fraught with the most sad consequences.

According to statistics, approximately 15% of children under 15 undergo surgery to remove an inflamed appendix. The most susceptible to the disease are babies aged 2-3 years, 7-8 years and 12-15 years. AT adolescence girls are especially at risk.

Most doctors associate the development of pathology with pollution and blockage along the different reasons appendix duct. This risk increases in proportion to the age of young patients.

At an early age, the cause is new products for the body of babies, as well as dirt and other mechanical particles that enter the intestines from infancy, when children are teething and they put everything in their mouths in a row. According to the well-known doctor, Dr. Komarovsky, parents of children under 5 years old should be more afraid of children's appendicitis, because the risk of complications is higher, but the opposite happens. There are prerequisites for inflammation of the appendix during stress, strong physical exertion, injuries and falls.

The cause may also be the resulting tumor, a congenital anomaly (twisting, bending) or infection. This is possible if there is infection bowel or chronic inflammatory disease.

Many doctors note that the blockage of the appendix duct can be associated with the following mechanical fillers:

fecal stone;
helminths;
blood clots resulting from a hematoma.

Classification of appendicitis in children

Depending on the nature of the course of the disease, it is divided into acute and chronic appendicitis.

Acute appendicitis

It develops very rapidly, bringing the state of the body to a critical moment already on the second day of the course of the disease. This is the most common form of the disease.

Chronic appendicitis

This is a sluggish type of disease. With such a disease, the patient from time to time complains of abdominal pain, sometimes turning into acute attacks, accompanied by nausea, vomiting, elevated temperature.

After some time, the attack subsides, and the child can only feel discomfort and nagging pain during palpation of the abdomen.

Due to the variety of positions in which the digestive organs are located in the body, appendicitis is divided into a typical and atypical form.

Typical appendicitis

Typical is called inflammation of the appendix, which is located in the right iliac region, smoothly descending to the small pelvis. In this position, it is in the body in more than 80% of people.

Atypical appendicitis

Retrocecal appendicitis is the most common of the atypical inflammation cases, occurring in about half of cases. The appendix is in the area right kidney, ureter, lumbar muscles, can fit close to them.

Pain in this location of the process is weakly expressed compared to the typical form, localized in the right hip joint, also a pain point often occurs in the lower back and in the groin. This can cause lameness, as the pain is aggravated by movement and it can be painful for the child to step on the foot.

The pelvic location is twice as rare as the previous type of atypical location of the appendix.

The location of the process under the liver is characterized by pain in the region of the liver.

Sometimes pain in children is localized in such places that the diagnosis of the disease is very difficult. The child may feel pain in the back, in the bladder, in the stomach. Children under 5 - 7 years old may not at all determine exactly where the stomach hurts.

There is also a classification according to the stage of development of the disease. Each pathology develops along an individual path, and it is not at all necessary that the disease will go through all stages. Surgery can stop the disease at an early stage in time.

catarrhal

The most common type of acute appendicitis, this form is the mildest and usually has no complications during the normal course of the operation. This form persists for about the first 12 hours of inflammation. Further, it passes into the phlegmonous type, which is accompanied by a deterioration in the patient's condition.

Phlegmonous

This is a destructive stage, coming after the catarrhal. It lasts for about a day. At this time, all the tissues of the appendix become inflamed. The mesentery (the organ that attaches parts of the intestine to the back of the peritoneum) swells and the disease moves to the wall abdominal cavity.

Gangrenous

It occurs on the second - third day, depending on the rapidity of the development of inflammation and is expressed in necrosis of the walls of the appendix.

empyema

Empyema is the result of blockage of the process by mechanical suspensions or due to scarring of tissues, as a result of which pus accumulates inside the appendix, tissue inflammation occurs. The positive point is the isolation of the appendix from other parts of the abdominal cavity.

Perforated form

This is a rupture of the wall of the appendix and the eruption of its contents into the abdominal cavity. At this stage, death is possible.

Symptoms of appendicitis in a child

Pain in the abdomen is the very first and characteristic symptom of inflammation. Initially, the pain is localized in the center of the abdomen, then, with a typical location of the appendix, it goes to the right lower abdomen, where the process is usually located. In children with atypical organ arrangement intestinal tract, the pain may, according to the type of location, manifest itself in the left lower abdomen, either in the back or in the pubic part. It is important to remember that such pain can also be a consequence of the development of appendicitis.
Temperature is a symptom accompanying any inflammation, which is more intense in children than in adults. In babies, the temperature at the catarrhal stage rises to 38 degrees and above, and when the disease passes into more severe stages, it can even reach 41 degrees, which in itself is fatal.

—FOOTNOTE— Acute pain in the abdomen, which is accompanied by a sharp rise in temperature in children, is already sufficient reason to immediately contact medical professionals.

The patient's stool in most cases is liquid, accompanied by flatulence. In rare cases, the opposite effect is observed - constipation.
Language state. Depending on the stage of development of the disease, the tongue gradually begins to become covered with a white coating, at first only at the base, gradually spreading to the tip. At the gangrenous stage, the tongue is completely covered with a white coating, dry mouth is observed.
Nausea and vomiting. Children are very sensitive to irritations of the mucous membranes, so quite often the development of appendicitis is accompanied by constant nausea and vomiting, resulting in dehydration and intoxication of the body.
Urination. With the pelvic location of the appendix, there may be frequent urge to urinate. But this symptom is by no means obligatory.
The pulse in this disease is rapid.

Age manifestations of appendicitis in children

Depending on the age of children, their perception of the disease and behavioral tendencies have significant differences, which is not surprising. For example, the symptoms of appendicitis in children at the age of 10 are not only external, like in infants, patients can describe them in detail, which is useful in diagnosis.

Inflammation of the appendix in children under 3 years of age

In children up to three years manifestations of appendicitis are judged mainly by outward signs and symptoms, since at this age children can tell almost nothing about their well-being.

Characteristic signs of the presence of pathology are the lack of appetite in the baby, insomnia or intermittent restless sleep, crying.

When the baby is calm, he lies motionless, because movements cause pain.

Symptoms of appendicitis in children aged 5-7 years

At this age, children already have the ability to conduct a dialogue about their well-being, they can respond to the actions of adults and comment on their feelings during palpation. Although it is not always possible for a child to understand his feelings, especially against the background of a general malaise aggravated by a disorder digestive system and high temperature.

The behavior of the child is reduced to trying to lie down, finding a position in which abdominal pain is minimized. True, it can be quite difficult to force a child to allow adults to conduct an examination and diagnosis, because the child understands that this will hurt him.

Features of appendicitis in children under 12 years of age

According to statistics, the largest number of operations among children under 15 years of age falls on the age of 10-12 years. This is due to the fact that the intestines of children and adolescents have not yet grown to the state of an adult, it is longer, which means that it is more prone to curvature and torsion. In addition, children at this age experience a lack of hygiene, and all this against the background of preparing the body for puberty and hormonal changes which affects the immune system and the state of the intestinal microflora.

Appendicitis in teenagers

Appendicitis among adolescents occurs in girls almost twice as often as in boys.

In boys, the disease can be confused with gastritis or another disease of the gastrointestinal tract or genitourinary system. But a visit to the doctor is indicated in all these cases, which means that the doctor will be able to make the correct diagnosis in time.

For girls, it's much more difficult. In adolescence, against the background of puberty, at the onset or before the onset of menstruation, girls often experience acute pain in the lower abdomen. This condition can last for several days, and therefore inflammation of the appendix can simply mix with these pains and not be noticed until the onset of severe stages of the disease.

Therefore, parents should carefully monitor the well-being of girls and, in the event of other symptoms characteristic of appendicitis, immediately sound the alarm.

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

In adolescents over 15 years of age, appendicitis manifests itself with the same symptoms as in adults. The differences in symptoms are as follows:

The temperature is much lower - 37 degrees on early stages disease and 38 in advanced stages.
Nausea can be episodic, vomiting single or double.

Diagnosis of appendicitis

Diagnostic methods at home

When examining a patient, a doctor can use various diagnostic methods that do not require special equipment, which means that parents can use some of them on their own if it does not harm the child.

For example, a method called Dieulafoy's Triad. When examining and probing the right iliac region, the doctor pays attention to three signs of appendicitis: pain when pressed and when released, muscle tension and special sensitivity (hyperesthesia). Using this method, you can diagnose appendicitis with a probability of 99%.

Medical diagnostics

In the hospital department, blood is taken to determine the presence of an inflammatory process, as well as a urine test to diagnose kidney problems.

In addition, they apply instrumental methods diagnostics, such as ultrasound, laparoscopy, radiography, fluoroscopy, irrigoscopy.

Treatment of appendicitis in children. Operation

In fact, the only treatment for inflammation is surgical removal of the process.

Sometimes there are times when acute inflammation goes away on its own if the cause of inflammation has somehow eliminated itself during the catarrhal stage of the disease. But the statistics of such cases is negligible, so it makes no sense to hope for it. Inaction is deadly.

In surgery, the operation to stop the process is considered one of the easiest.

But if you start it, then the operation to remove appendicitis with complications can turn into one of the most difficult in surgical practice.

Modern surgery provides for the endoscopic method of removing the appendix. With this type of intervention, the incision on the body is less than 3 centimeters, blood loss and tissue damage are minimal, and the likelihood of complications is practically excluded. True, this type of operation is indicated mainly at the catarrhal stage of the disease. If the disease has spread, then drastic measures are needed to stop its consequences.

How to help a child at home

First of all, waiting medical workers, the task is not to harm the patient, and to minimize the possible consequences.

Therefore, in order not to lubricate the clinical picture of the disease, one should not give the child medicines, especially painkillers, because the main doctor's appointment during the initial examination is palpation of the abdominal cavity, in which it is necessary to understand how the sick organism responds to the doctor's actions. Do not apply heating pads to the abdomen and should refrain from folk methods medicine.

The main thing to do is to provide the patient with peace in the supine position.

Complications of appendicitis in children

Complications of this disease can occur in two situations: in the absence of timely diagnosis and treatment, as well as in postoperative period for various reasons, from medical negligence to physiological characteristics and consequences of other diseases of the body.

The complications of appendicitis include such diseases as diffuse and local peritonitis, liver abscesses, sepsis, appendix perforation, infiltrate, various thrombophlebitis. Such complications often lead to the death of the patient, or, at best, to months and years of recovery of the body.

Prevention of appendicitis

There are no such measures, having taken which one could speak of any reliable protection against this inflammation. However, there are a number of tips, following which you can say that your behavior will not cause the disease.

First of all, you need to monitor what the child eats. Healthy food is the key to health, because the child's immunity plays an important role in the fight against any disease and inflammation.

People say that eating sunflower seeds along with the peel can cause clogging of the canals of the process. There is a rational grain in this, because statistical studies were carried out in Spain. It turned out that there is a high percentage among children who, on the eve of getting into the hospital, ate this product.

Also, if possible, stressful situations, injuries and bruises should be avoided, therapy and prophylaxis against helminths should be carried out in a timely manner.

Conclusion

In conclusion, it should be noted that there is no way to absolutely exclude the development of appendicitis in a child, but there are indications to increase the chances of avoiding it. In any case, if you suddenly suspect that your son or daughter has inflammation, then it does not matter who is to blame and what is the reason. The only important thing is to know what to do. And here's what you need to do: immediately call an ambulance.

The indifference of adults to the problems of children and the modern possibilities of medicine give the treatment of appendicitis a positive prognosis in almost 99 percent of cases. And that means everything is in our hands.

Alexandra is a constant expert of the PupsFull portal. She writes articles on pregnancy, parenting and training, child care and child health.

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 poor quality products can also easily cause inflammatory process in the intestine. Admission a large number crude fiber can provoke acute inflammation of the terminal part of the caecum, causing disease.

The most common cause of appendicitis is 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 arose 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 of 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. The most dangerous variant of 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 every mother to be familiar with the manifestations of this disease in order to easily recognize a 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, characteristic pains appear 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.

To make an accurate diagnosis, you need to take the child to the hospital. Without fail, he will do 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 can lead to the development of peritonitis or septic shock in 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 of the gastrointestinal tract. Vitamin therapy will help to quickly restore the child's immunity. All physical activities (and even more so visiting sports sections) are resolved 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

To the most frequent complications Appendicitis can include:

development of peritonitis. If medical care was not provided in time or the disease proceeds in an aggressive and dangerous form, inflammation of the peritoneum may occur. This significantly worsens the prognosis and requires urgent surgery.
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 is suspected late (or a surgical operation is not done in time), due to severe inflammation, the intestinal contents can pour 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, severe symptoms of dehydration appear. 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 pureed 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. A therapeutic diet is recommended to be followed for one to two months. This will allow the inflamed intestinal wall to recover quickly, the weak children's body will strengthen.

Basic principles of therapeutic 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 postoperative period 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 table salt can be added to food. 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 the operation, fresh fruits and vegetables can only be eaten 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. The most correct cooking methods would be boiling or cooking in a slow cooker, double boiler.
As the right carbohydrates, use well-boiled cereals. 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, if the following conditions are met, you can somewhat 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 call an ambulance or pediatrician should definitely.

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

Update: December 2018

Appendicitis is one of the most common surgical pathologies the abdominal cavity, the cause of which is inflammation of the appendix - the appendix of the caecum. The disease needs urgent surgical treatment. In this article, we will tell you what signs of appendicitis can be in children.

Types of appendicitis

Depending on the course of appendicitis, there are two main types - acute and chronic. Clinical and anatomical classification of appendicitis in children includes the following varieties:

catarrhal appendicitis is the simplest and most common form of the disease. At the same time, swelling and hyperemia of only the mucous membrane of the appendix, accumulation of serous exudate in the abdominal cavity are noted.
phlegmonous appendicitis - accompanied by inflammation of all layers of the process, its cavity contains pus, and the surface is covered with fibrin stains.
- proceeds with necrosis of the walls of the appendix.
empyema of the appendix - empyema of the appendix is accompanied by an accumulation of pus in its lumen
perforated form of appendicitis - accompanied by a rupture of the wall of the appendix and the outpouring of its contents into the abdominal cavity.

Symptoms of appendicitis in children

Acute appendicitis in children can be at any age, however, most often it is recorded at 5-14 years old, boys get sick 2 times less often than girls. In children, unlike adults, the symptoms of appendicitis have some features that are due to the structure of the appendix and the weak development of its lymphoid tissue. In children, the appendix is often located retrocecally (behind the caecum) and subhepatic, which causes a special picture of the disease.

The main signs of appendicitis in children:

pain in the abdomen of different localization (depending on the location of the appendix)
signs of anxiety (sleep disturbance, refusal of food, crying)
rise in temperature to high levels
tachycardia (increased heart rate)
stool disorders (constipation, diarrhea)
bloating
vomit
urination disorder

In children, appendicitis has a sudden onset and rapidly increasing symptoms. Sharp aching pains appear, which, like in adults, most often begin in the epigastric region, and then descend to their typical place - the right iliac region (characteristic of the typical location of the appendix).

A research group of scientists in Madrid conducted a study of 3,000 clinical cases of acute appendicitis and found that in 40% of cases, patients who had consumed chips or fried sunflower seeds the day before were admitted to the hospital, this was especially often recorded in adolescents under 14 years old.

If the appendix is located atypically, for example:

retrocecal (behind the caecum) - there are pains in the lumbar region, radiating to the groin;
with pelvic localization of the appendix - pain is noted in the lower abdomen and above the pubis;
with subhepatic localization of the process - pain in the liver.

Sometimes pain in children can have a rare localization - give to the back, perineum and genitals, ureter, stomach, which makes it difficult to diagnose the disease (see).

Children with appendicitis often take a forced lying position, often on the left side with legs brought to the stomach (this position makes the pain moderate, as the tension of the peritoneum and mesentery decreases). Children are not allowed to touch their stomach, preventing the examination, so it is best to examine them during physiological or medication sleep.

Small children cannot indicate the presence of pain, they show obvious anxiety - they cry, scream, refuse food and sleep. At the moments when the children calm down, they lie without moving in one position. Their face is reddened, their tongue is covered with a white coating, tachycardia, an increase in temperature, sometimes reaching up to 38 degrees and above (especially in young children), are noted. In older children, there is a discrepancy between the pulse and temperature - a symptom of "scissors".

One of the signs of appendicitis in a child is vomiting, it can be different - single or multiple, but in any case does not bring relief to the child. In young children (under 3 years of age), appendicitis may be painful when urinating.

When examining a child who is suspected of having typical appendicitis, most of the symptoms characteristic of diagnosing appendicitis in adults are also positive: the symptom of Shchetkin-Blumberg, Razdolsky, Sitkovsky, Rovsing. In children with retrocecal localization of appendicitis, tension in the abdominal muscles and pain on palpation are less pronounced, Shchetkin-Blumberg's symptom may be negative. For pelvic appendicitis clinical picture can also be erased, but rectal examination is more informative, in which the infiltrate is palpated.

If you experience abdominal pain in a child, you should not start any treatment on your own without establishing the cause of its occurrence, you should definitely call a doctor. There are several ways to suspect appendicitis in children older than 7 years, which can be carefully done by parents before the doctor arrives:

If the child coughs loudly, then the pain in the right iliac region will increase - this may be a symptom of appendicitis.
Typical for appendicitis is also such a symptom - when turning the child on the left side from the back, then there is an increase in pain in the right iliac region
If the child, lying on his right side, pulls his legs to the body and the pain decreases, this may be a sign of appendicitis. And after that, straighten his legs and turn on his left side, then the pain will intensify.
You can not feel the stomach with your fingers on your own, for a child it can be very dangerous. To compare pain in the right and left iliac region, only light tapping with a fingertip is possible, if the child feels pain on the left side, but not on the right side, this can also be a symptom of appendicitis in a child.

Such a self-diagnosis can only be done in order to immediately call if there is serious suspicion. ambulance. When the diagnosis is established - acute appendicitis, an emergency operation is indicated, this is not a complicated surgical intervention, usually the child is discharged after a week.

American scientists consider ultrasound to be the most ineffective method for diagnosing appendicitis, especially in children, since it leads to frequent diagnostic errors, offering to replace it with CT. However CT scan not safe for children because radiation exposure increases the risk of cancer in children to a greater extent than in adults, especially brain tumors and leukemia. But with questionable symptoms and an uncertain diagnosis, if a child's appendicitis or brain hemorrhage is suspected, a CT scan can save his life, so you should always correctly assess the risks.

What provokes unscrew appendicitis in a child? There can be many provoking factors that cause inflammation: an infection in the appendix, a violation of the functions of the gastrointestinal tract, anatomical features the location of the process, less often the cause is penetration into the process foreign bodies. The connection between inflammation of appendicitis and the child's lifestyle, physical activity or hereditary disposition has not been established.

What can not be done if you suspect appendicitis? When a child complains of pain, the natural behavior of parents is to give the child pain medication. This should not be done as pain relief will make diagnosis difficult. Also, you can’t warm up the stomach, offer it to the child, this will lead to increased inflammation and only worsen the child’s condition.

Differential diagnosis of appendicitis in children from other diseases

In children differential diagnosis acute appendicitis is carried out with such diseases:

SARS (acute respiratory viral infections)
gastrointestinal diseases
coprostasis
urological diseases
pneumonia
measles, rubella, hepatitis, chickenpox, scarlet fever (also characterized by abdominal pain)
intussusception

Respiratory infections in children early age(), like appendicitis, can be manifested by abdominal pain, vomiting and fever. However, they are accompanied by corresponding changes in the mucous membranes of the nose and throat, the presence of discharge from the nose, and symptoms of conjunctivitis. A distinctive symptom of appendicitis in a child is abdominal syndrome, painful palpation of the abdomen, there is a passive tension of its muscles.

Pneumonia is a pathology that can be accompanied by abdominal pain that mimics appendicitis. In such cases, the dynamics of the process is important. Pneumonia is accompanied by increasing shortness of breath, cyanosis of the nasolabial triangle, over time moist rales appear over the lungs, weakening of breathing, which does not happen with appendicitis. The diagnosis is confirmed by the results of an X-ray, in which signs of pneumonia are visible to the naked eye.

Otitis in children (especially small ones) can also mimic the picture of appendicitis. They are also restless, crying and sleeping poorly. However, with otitis in children, the abdomen is absolutely painless, there is no tension in its muscles. Pressing on the tragus of the ear with otitis media causes the baby to cry and worry.

Intussusception, unlike appendicitis, has more pronounced symptoms: sharp pains in the abdomen, bleeding from the rectum. On palpation of the abdomen, there is no tension in the abdominal muscles and symptoms of peritoneal irritation. The diagnosis of intussusception is confirmed by x-ray examination of the abdominal cavity.

Article last updated: 04/20/2018

When most adults have a stomach ache, they simply relieve the pain with pills and get on with their day. If she's really strong, then maybe they'll stay at home. For the most part, we adults can tell if something is serious or not. If we think that it hurts more than usual, we turn to doctors for help.

When it comes to children, it's a completely different story. Children often have stomachaches. This can be due to a variety of reasons - not eating enough, too much or just the wrong food. It's almost impossible to tell if your baby's stomach ache is for a serious reason or if it's something minor.

Pediatrician, gastroenterologist

One of possible causes abdominal pain in a child is appendicitis. This is a serious problem that requires urgent treatment.

Appendicitis is an inflammation of a part of the intestine called the appendix. It is a narrow finger-shaped pouch located at the junction of the small and large intestines.

The reasons

If blood flow is reduced, the appendix begins to die. When a tear (perforation) appears in the walls of the appendix, it allows feces, mucus, and other substances to enter the abdominal cavity. This provokes the development of peritonitis - an infectious inflammation of the peritoneum, which is a formidable complication.

As a rule, acute appendicitis in children occurs between 8 and 16 years of age. But babies under 5 can also experience this condition, which often has more serious consequences, as they are unable to clearly communicate their symptoms.

How to recognize appendicitis in a child?

Although many children have the same symptoms of appendicitis as adults, it is often more difficult for doctors to diagnose appendicitis in a child. Especially when patients are too small to accurately describe their feelings and formulate complaints.

In addition, the study showed that the symptoms of appendicitis in children may differ from the signs of the disease in adults.

The main symptoms of appendicitis

Appendicitis has many symptoms, but there are some classic signs that many children and adults experience.

Adults with appendicitis may have a slight increase in body temperature. Children with appendicitis have a higher and more pronounced fever.

Studies have shown that in children from 2 to 5 years old, with the development of appendicitis, the stomach most often hurts and vomiting appears. Fever and loss of appetite are also common.

2. Shchetkin-Blumberg symptom.

A symptom that is very specific to children. It is checked by pressing on the stomach in the projection of the appendix - in the area below the navel on the right. If you press the fingers of the hand, and then abruptly release, the pain intensifies. This indicates inflammation of the sheets of the peritoneum. The symptom in this case is considered positive.

In addition to the childhood symptoms listed above, any or all of the following common signs of appendicitis in children may be present.

3. Loss of appetite.

One of the signs of appendicitis in a child is a lack of appetite.

If your child refuses food and this is uncharacteristic for him, you should definitely pay attention to this.

4. Nausea and vomiting.

Nausea and/or vomiting are also typical symptoms of appendicitis.

Most often, nausea and vomiting occur in children after the onset of abdominal pain.

One of the signs of appendicitis is a dull pain in the navel or upper abdomen that becomes sharp as it moves to the lower right abdomen. Usually this is the first sign. In almost half of the cases, other symptoms of appendicitis appear, including dullness or sharp pain in the upper or lower abdomen, back, or rectum.

6. Inability to get rid of accumulated intestinal gas.

Since appendicitis is usually caused by an obstruction in the bowel, many children with appendicitis cannot pass gas, which creates additional discomfort.

7. An increase in the size of the abdomen.

Appendicitis develops when the appendix of the intestine swells and becomes inflamed, so it is often found that the abdomen becomes larger in children.

Although an enlarged abdomen can be a symptom of many diseases, it is a sure sign of appendicitis when combined with the other symptoms previously mentioned.

8. Constipation or diarrhea.

Although they are not as common as other symptoms, they are present in about half of the cases.

In addition In addition to the above symptoms, there are other, less common signs:

severe spasms;
painful urination and difficulty passing urine;
bloody vomit or stools;
inability to straighten up;
pain that worsens during sudden movement (coughing, sneezing);
bloating;
green liquid vomit. It may be bile, which indicates obstruction of the stomach or intestines;
child complains about severe pain in the stomach, lying on its side with legs drawn to the stomach;
the child complains of abdominal pain when walking.

Appendicitis is the most common reason for abdominal emergency surgery. Approximately 5% of people develop appendicitis during their lifetime. The peak age for the onset of appendicitis is between 10 and 30 years of age.

The overall number of cases of appendicitis is decreasing. Experts say this is due to the fact that people eat more fiber, which helps prevent blockage and the development of intestinal obstruction.

Risk factors

Heredity matters, and men are more susceptible than women. If the child has cystic fibrosis ( hereditary disease, problematic digestion and respiratory diseases), he is also more likely to develop appendicitis.

Since children often develop abdominal pain, this is not necessarily a sign of something serious.

Usually, the abdominal pain experienced by a child is the result of a non-life-threatening condition, such as excess gas, streptococcal infection, swallowing large amounts of air, restlessness, or mild pain.

Appendicitis is difficult to diagnose because of its various symptoms, so it's important to call the doctor if you notice that your child has been suffering from abdominal pain for more than a day or more than one of the above symptoms.

Again, when you're not sure, call your doctor - it's much better to catch appendicitis early.

Survey

Diagnosing appendicitis can be challenging. Symptoms are often vague or very similar to other illnesses, including gallbladder problems, bladder or urinary tract infections, gastritis, Crohn's disease, and ovarian problems.

The following tests are commonly used to make a diagnosis.

Abdominal examination (examination, palpation, percussion, auscultation) to detect inflammation.
Urinalysis to rule out urinary tract infection
Rectal examination
Blood test to detect infection
Computed tomography and/or ultrasound

The specific treatment for appendicitis is determined by the child's doctor based on the following criteria:

Because of the likelihood of rupture of the appendix and the development of severe, life threatening infections, experts recommend removing the appendix with surgery.

The appendix can be removed in two ways.

public method

During anesthesia, an incision is made in the lower right abdomen. The surgeon finds the appendix and removes it. When the appendix is torn, a small drainage tube may be placed to allow pus and other fluids in the abdomen to drain out. The tube will be removed after a while, when the surgeon sees that the infection has subsided.

Laparoscopic method

In this procedure, several small incisions are made and a camera (laparoscope) is used to view the inside of the abdomen during the operation. Under anesthesia, the laparoscope and the instruments the surgeon uses to remove the appendix are placed through several small incisions. This method is usually not used if the appendix has ruptured.

After the operation, the child is forbidden to eat or drink anything for a certain period of time. Fluids are introduced into the bloodstream through small plastic tubes until the child is allowed to drink fluids.

A child whose appendix has ruptured will have to stay longer in the hospital. Some children will need to take antibiotics after returning home for the period of time indicated by the doctor.

At the time of discharge from the hospital, the doctor will usually recommend that the child does not engage in weightlifting, do not participate in sports for several weeks after the operation. If the drain tube is still in place when the child goes home, then the child should not take a bath until the tube is removed.

Appendicitis is one of the most common pathologies of the abdominal cavity, requiring emergency surgical intervention, which develops due to inflammation of the appendix.

Types of appendicitis

Depending on the nature of the course of the disease, appendicitis is divided into two main types - chronic and acute. Clinical and anatomical classification of inflammation of the appendix in children includes the following varieties:

the perforated form of appendicitis implies a rupture of the wall of the appendix and the outpouring of its contents into the abdominal cavity itself;

empyema of the appendix - accumulation of pus in the lumen of the appendix;

gangrenous appendicitis - accompanied by necrosis of the tissues of the walls of the appendix;

phlegmonous appendicitis - inflammation of all layers of the process, while its surface is covered with fibrin spots, pus accumulates in the cavity;

catarrhal appendicitis is the simplest and most common form of pathology. Accompanied by hyperemia only of the mucous membrane of the appendix, swelling, accumulation of serous exudate in the abdominal cavity.

Symptoms of appendicitis in children

Acute appendicitis can develop in children at any age, but the most common disease occurs from 5 to 14 years, while in boys the pathology occurs 2 times less often than in girls. Compared with adults in children, the symptoms of appendicitis are somewhat different, due to the weak development of the lymphoid tissue of the appendix and some differences in the structure of the appendix. In children, the appendix is quite often localized behind the cecum (retrocecal) and subhepatic, which causes a special picture of the disease.

Typical signs of appendicitis in a child:

increase in body temperature to high levels;

signs of anxiety (crying, refusal of food, sleep disturbance);

abdominal pain of various localization (depending on the location of the appendix);

violation of urination;

bloating;

violation of the stool (diarrhea, constipation);

increased heart rate (tachycardia).

In children, appendicitis develops suddenly and has a rapidly growing symptomatology. As in adults, the child develops sharp aching pains in the epigastric region, which gradually descend to the place of typical localization, in the right iliac region (with a typical location of the appendix).

Spanish scientists conducted a study of three thousand cases of acute appendicitis, during which it was found that in 40% of cases of admission to the hospital, the patient consumed fried sunflower seeds or chips the day before, especially often such cases were recorded in adolescents under the age of 14 years.

Symptoms of an atypical location of the appendix:

pain in the liver area - with subhepatic localization of the appendix;

pain above the pubis and in the lower abdomen - with the pelvic localization of the process;

pain in the lumbar region, radiating to the groin - with retrocecal localization of the process (behind the caecum).

In some cases, pain in children can have a rather rare localization - give to the stomach, ureter, genitals, perineum, back, which creates additional difficulties for diagnosing the disease.

Children with inflamed appendicitis often take a forced position, in most cases it is lying on the left side with legs pulled up to the stomach (by reducing the tension of the mesentery and peritoneum, the pain becomes moderate). In addition, the child often forbids touching his stomach, which greatly complicates the examination, so it is much easier to conduct an examination when the child is in a state of medical or physiological sleep.

Young children cannot independently indicate the presence pain, therefore, they become restless - refuse sleep, food, scream, cry. In moments of calm, the baby prefers to lie still, freezing in one position. There is an increase in body temperature up to 38 degrees (in young children, the temperature may be higher), tachycardia is noted, there is a white coating, the face becomes reddened. In older children, there is a so-called "scissors" symptom, when the temperature does not correspond to the pulse rate.

Signs of appendicitis in a child

One of the signs of an exacerbation of appendicitis in a child is vomiting, which can be repeated or single, and in any case it does not bring relief to the child. In children under 3 years of age, one of the symptoms of appendicitis may be pain when urinating.

During the examination of a child with suspected typical appendicitis, a positive response has most of the symptoms that are characteristic in the diagnosis of appendicitis in adults: a symptom of Rovsing, Sitkovsky, Razdolsky, Shchetkin-Blumberg. With retrocecal localization of appendicitis, pain and tension of the abdominal muscles during palpation are mild, and the Shchetkin-Blumberg symptom may have a negative result. With pelvic appendicitis, the main clinical picture may be somewhat blurred, but a rectal examination becomes more informative, during which the infiltrate is probed.

If a child has abdominal pain, it is forbidden to carry out self-treatment without first establishing the cause of their occurrence. It is imperative to call a doctor. For children over 7 years old, there are several ways to suspect appendicitis, which can be done with extreme caution by parents before the doctor arrives:

If the child in the supine position on the right side, when pulling the legs to the stomach, feels a weakening of pain manifestations, and when straightening and turning over to the left side, the pain intensifies, this may indicate acute appendicitis.

Also characteristic symptom with appendicitis, there is an increase in pain in the right iliac region when the child is turned over to the left side from the back.

When coughing, pain in the right iliac region increases, which is one of the symptoms of appendicitis.

Self-palpation of the child's abdomen with fingers is not allowed, as this can cause significant harm. To compare pain in the left and right iliac regions, you can only lightly tap with a fingertip, and if the child feels pain on the left side, but not on the right side, this can also be one of the symptoms of appendicitis.

Such self-diagnosis is permitted only in order to promptly call in case of serious suspicion. emergency care. When confirming the diagnosis of "acute appendicitis", an emergency operation is indicated. This is a relatively simple surgical intervention, after which, in most cases, the child is discharged after a week.

American scientists consider ultrasound to be the most ineffective methods for diagnosing appendicitis, especially when making a diagnosis in children, since this method leads to frequent errors, so it is proposed to replace it with a more informative CT scan. However, CT scans are accompanied by radiation, which, if exposed frequently, increases the risk of oncological diseases (especially leukemia and brain cancer), and this risk is higher in children than in adults. But still, with an uncertain diagnosis and symptoms in the case of acute appendicitis or cerebral hemorrhage, computed tomography can save the child's life, so it is important to correctly assess the risks.

Factors provoking the development of appendicitis

Factors that can trigger the appearance of inflammation of the appendix include:

anatomical features of the location of the appendix;

dysfunction of the gastrointestinal tract;

infection in the appendix;

penetration into the process of foreign bodies (rarely).

Hereditary predisposition and the relationship of inflammation of appendicitis with physical activity or the child's lifestyle has not been established.

If appendicitis is suspected, it is forbidden to give the child painkillers, since its effect can make diagnosis difficult. Also, in no case should you warm up the child's stomach with a heating pad and other devices, as this will increase inflammation and lead to a deterioration in the child's condition.

Differential diagnosis of appendicitis in children from other diseases

Differential diagnosis of acute appendicitis in children is carried out with such diseases:

intussusception;

scarlet fever, chickenpox, hepatitis, rubella, measles (also accompanied by abdominal pain);

pneumonia;

urological diseases;

coprostasis;

diseases of the gastrointestinal tract;

acute respiratory viral infections (ARVI).

Respiratory infections in young children can be accompanied, like appendicitis, by abdominal pain, fever, and vomiting. However, ARVI occurs with characteristic changes in the mucous membranes of the throat and nose, the presence of nasal discharge and symptoms of conjunctivitis. A distinctive symptom in the presence of inflammation of appendicitis in a child is abdominal syndrome - passive tension of the abdominal muscles and pain during palpation.

Pneumonia may be accompanied by abdominal pain that mimics appendicitis. With such a development of the disease, the dynamics of the process is important. With pneumonia, there is increasing shortness of breath, cyanosis of the nasolabial triangle, after a while moist rales and weakening of breathing appear, which are not characteristic of appendicitis. The diagnosis is confirmed by X-ray examination. On the radiograph of the lungs, signs of pneumonia have a pronounced manifestation.

Otitis in a child (especially a small one) can also copy the picture of appendicitis. At the same time, children do not sleep well, cry, and are restless. However, with otitis in a child, the abdomen remains painless, and there is no passive tension of its muscles. While pressure on the tragus of the ear causes a new fit of anxiety and crying in the child.

Intussusception compared to appendicitis has more pronounced symptoms: bleeding from the rectum, sharp pains in the abdomen. On palpation, there are no symptoms of peritoneal irritation and tension of the abdominal muscles. Confirmation of the diagnosis of intussusception is achieved by x-ray examination of the abdominal cavity.