Çocukluk Çağı Apandisit Olguları Ve Apendikolitin Şüpheli Karın Ağrılarındaki Yeri

Abstract

Çocuklarda akut karýn etiyolojisinde birden çok etken rol oynamaktadýr. Çalýþmamýzda apendikolitin çocukluk çaðý karýn aðrýsý etiyolojilerindeki yeri deðerlendirildi. 2002-2006 yýllarýnda karýn aðrýsý tanýsý ile kliniðimizde tedavi edilen 319 hastanýn dosya bilgileri geriye dönük olarak incelendi. Opere edilen 155 hastada; 101 akut apandisit, 27 perfore apandisit, 7 meckel divertikülit bulundu. Negatif laparatomi yapýlan 20 olgudan 9' unda hiçbir patoloji bulunmazken, 7' sinde mezenter adenit, 4' ünde ise lümenini týkayan fakat apendikste morfolojik deðiþiklik oluþturmayan fekal içerik saptandý. Karýn aðrýsý ile yatýrýlan ve müphem fizik muayene bulgularýna baðlý olarak gözlenen 164 hastanýn izlem sonuçlarýnda; 85 olguda mezenter adenit, 19 olguda gastroenterit, 8 olguda tonsillit veya otit, 3 olguda ailesel akdeniz ateþi, 1 olguda hidrosalpinks saptanýrken 21 olguda karýn aðrýsýna yol açan cerrahi nedeni bulunamadý. 27 olguda ise sonografik olarak deðiþik oranlarda apendiks duvarýný çapýný artýran ve apendiks lümenini týkayan fekal içerik (apendikolit) saptandý. Bu hastalar müphem yakýnmalarý ve fizik muayene bulgularýna baðlý olarak gözlemlendi. Gözlemde klinik yakýnmalarý gerileyen ve sonografik bulgularý kaybolan hastalar yakýn takiple taburcu edildi. Klinik serimizde apandikolitin apandisite neden olduðu gibi gerçek cerrahi bir patoloji olmaksýzýn akut karýn benzeri aðrýya da neden olabileceði görülmüþtür. Sonuç olarak; apandikolit çoðu kez hekimleri cerrahi patoloji açýsýndan tedirgin etse de sonografik olarak apandikolit tanýsý tek baþýna taný için yeterli deðildir. Bu olgularýn yakýn takibini önermekteyiz.

Keywords

• Çocuk, akut karýn, apandikolit, apandisit

CHILDHOOD APPENDICITIS CASES AND ROLE OF APPENDICOLITHS IN SUSPICIOUS ABDOMINAL PAIN

Abstract

Various factors play a role in childhood acute abdomen etiology. In our study we evaluated the role of appendicoliths in childhood abdominal pains and appendicitis. Official records of 319 patients who referred with abdominal pain between the years 2002 to 2006 years were evaluated. ( Among the 155 patients being operated )101 appendicitis, 27 perforated appendicitis, 7 meckel diverticulitis were found. 20 false laparatomies were distributed as; 9 with no obvious pathology, 7 with mesenteric adenitis, 4 with appendicoliths obstructing the lumen but no macroscopic change in appendix. The results of 164 patients hospitalized due to abdominal pain and observed according to suspicious examination findings were; 85 mesenteric adenitis, 19 gastroenteritis, 8 tonsillitis or otitis, 3 familial mediterranean fever, 1 hydrosalphinx and 21 with no obvious etiology. In 27 cases fecal particles (appendicoliths) obstructing appendix lumen and leading to inerease in outer diameter of appendix wall were detected by sonographically. Those patients were observed medically according to their mild and suspicious clinic of abdominal pain. These Patients were discharged with close follow up according to improving clinic complaints and sonographic findings. In our serial, we detected that appendicoliths can mimic acute abdominal pain without any real underlying surgical pathology. As a consequence; despite appendicoliths mostly disturbs physicians for a surgical intervention, sonographical appendicoliths diagnosis is not a sufficient criteria for differential diagnosis. So we suggest close follow up in such patients

Keywords

• Children, acute abdomen, appendicoliths, appendicitis

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