Abstract

GARCIA CAMINO, E. et al. Appendicitis in children under four years: identifying signs, symptoms, laboratory and imaging parameters for an early diagnosis. Rev Pediatr Aten Primaria [online]. 2014, vol.16, n.63, pp.213-218. ISSN 1139-7632.  https://dx.doi.org/10.4321/S1139-76322014000400005.

Introduction: acute appendicitis in children under 4 years old shows a high incidence of complications due to a late diagnosis such as peritonitis, in comparison to other ages. This study is aimed to find data in order to achieve an early diagnosis to reduce their incidence. Methodology: retrospective study for children under 4 years with confirmed diagnosis of acute appendicitis from pathological sample. Demographic, clinical, laboratory, imaging, anatomical pathology and surgical complications data were recorded and analyzed. Results: eighty-two patients were enrolled, and a 1.5:1 ratio of male/female was found, which varied by age group, where 85.7% of female in children under 2 years and 43.2% between 2 and 4 years were found. The most frequent symptoms were progressive abdominal pain, vomiting, anorexia and malaise. The most common signs were tenderness in right lower quadrant, rebound pain and fever. There were no differences in laboratory, radiological or anatomical pathology findings. Peritonitis was more frequent in patients with fever >38.5 ºC on the first day (OR 3.36; p=0.009). No significant relationship was observed between age and increased risk of peritonitis. Conclusions: acute appendicitis in children under 4 years is still a diagnostic challenge. Symptoms and signs are similar to classic appendicitis, though most frequently associated malaise and high fever and short evolution. Fever is related to a three times higher risk of appendical perforation and peritonitis, especially in women younger than 2 years.

Keywords : Appendicitis; Early diagnosis; Intestinal perforation; Peritonitis; Preschool child; Infant.

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