Acute Appendicitis

Epidemiology
• is the most common case of emergency surgery in children and
adolescents.
• There are approximately 250,000 cases of appendicitis
occurring in the United States each year and mainly occur in
children aged 6-10 years.
Etiology
• the obstruction of the appendix lumen resulting in vascular congseti,
ischemic necrosis and consequently infection
• The most common cause of obstruction is fecolith. Fecolith is found in
about 20% of children with appendicitis
• Other causes of appendix obstruction include: Carcinoid lymphoid
follicle hyperplasia
Pathogenesis
Appendicitis occurs from mild inflammatory processes to
perforation, typical within 24-36 hours after onset of symptoms,
followed by abscess formation after 2-3 days. Appendicitis can
occur due to various causes, including obstruction by fecalith,
gallstone, tumor, or even by worms (Oxyurus vermicularis), but
most often caused by fecalith obstruction and then followed by
inflammatory processes.
Diagnosis
Physical examination:
- Tenderness mc. Burney (+)
- Pain off (+)
- Muscular Defens (+)
- Rovsing sign (+)
- Psoas sign (+)
- Obturator sign (+)
Supporting investigation :
- Examination of Plugs feces: Right
quadrant pain will be obtained
at 9-12 hours. In pelvic
appendicitis there will be limited
pain when the rectal plug is
applied.
- Abdominal X-Ray: Used to see
fecalith as the cause of
appendicitis.
Differential Diagnosis
• In children under five are other intussusception, diverticulitis,
and acute gastroenteritis. Intussusception is most commonly
seen in children under 3 years of age.
• Diverticulitis pain is similar to Appendicitis, but the location is
different, that is, in the periumbilical region.
• The rather difficult diagnosis of appeal is acute gastroenteritis,
because it has symptoms similar to appendicitis, ie diarrhea,
nausea, vomiting, and leukocytes found in the feces.
Management
• For patients suspected of Appendicitis: Get rid and Give analgesics
and antiemetics if necessary to reduce symptoms
• Give IV antibiotics to patients with sepsis and who need Laparotomy
• Preoperative antibiotics are effective in reducing postoperative
infections
Prognosis and Complications
• Prognosis: appendicomes performed before perforation have a good
prognosis. Death can occur in some cases. After surgery infection can
still occur in 30% of cases of appendix perforation or appendix
gangrenous
• Complications: Appendicular infiltrates, Appendicular abscess,
Perforation Peritonitis, Septic shock, Mesenterial pyemia with Hupar
Abscess, Peripaltic disorders of the ileus