It's not always appendicitis: relatively uncommon conditions of acute abdomen in children

Yıl 2021, , 215 - 219, 25.03.2021

Berat Dilek Demirel , Beytullah Yağız

https://doi.org/10.16899/jcm.863986

Öz

Aim: To evaluate the acute surgical conditions beyond acute appendicitis in children.
Material and method: The children who underwent urgent abdominal surgery between January 2017-December 2020 are retrospectively evaluated. The newborns and patients with acute appendicitis are excluded.
Results: A total of 595 patients underwent urgent abdominal surgery. Acute appendicitis was the final diagnosis in 468 of them (78.7%). The median age of the rest of the 127 patients (21.3%) was 8 years (0.96-17.75 years). Fourteen patients admitted with trauma (11%) (12 boys and 2 girls, median age; 12.66 years), and the most common cause was firearm injuries with the most common injured system was the gastrointestinal system. Among the patients without trauma, 62 were boys (54.6%) and 51 were girls (45.1%) (median age; 6.41 years). Intussusception was most common in the Infant and Young Child Group. Adhesive small bowel obstruction was most common in adolescent boys and the Child Group while adnexal torsion was most common in adolescent girls. Intussusception, adhesive small bowel obstruction and gastrointestinal perforation were encountered in all age groups
Conclusion: Although acute appendicitis is the most common cause of acute abdomen in children, other causes are not uncommon and some need special attention as differential diagnosis and intervention are "more urgent" than others. Awareness of these "more urgent" conditions with respect to age groups may prevent complications, morbidity, and even mortality.

Anahtar Kelimeler

abdomen, acute, intussusception, adnexal torsion, intestinal obstruction

Her zaman apandisit değildir: çocuklarda nadir görülen akut karın nedenleri

Öz

Amaç: Çocuklarda akut apandisit dışı akut cerrahi nedenlerin değerlendirilmesi.
Gereç ve yöntem: Ocak 2017- Aralık 2020 tarihleri arasında acil karın cerrahisi yapılan çocuk hastalar retrospektif olarak değerlendirildi. Yenidoğan dönemindeki hastalar ve apandisit nedeniyle ameliyat edilen hastalar çaışma dışı bırakıldı.
Bulgular: 595 hastaya acil abdominal cerrahi yapıldı. 468'inde (%78,7) kesin tanı apandisitti. Apandisit dışı nedenle ameliyat edilen 127 hastanın (%21,3) ortanca yaşı 8 (0,96- 17,75) yıldı. Travma ile başvuran 14 (%11) hasta vardı (12 erkek, 2 kız, ortanca yaş; 12,66 yıl). En sık travma nedeni ateşli silah yaralanması ve en sık yaralanma gastrointestinal sistemde yaralanmasıydı. Nontravmatik Grupta 62 (%54,6) hasta erkek ve 51 (%45,1) hasta kızdı ( ortanca yaş; 6,41 yıl). İnfantlarda ve küçük çocuklarda en sık invajinasyon görüldü. Ergen erkeklerde ve Çocuk Grubunda en sık adhesiv barsak tıkanıklığı görülürken, ergen kızlarda en sık adneksiyal torsiyon görüldü. İnvajinasyon, adhesiv barsak tıkanıklığı ve gastrointestinal perforasyon tüm yaş gruplarında görüldü.
Sonuç: Çocuklarda en sık akut karın nedeni akut apandisit olsa da, diğer nedenler de nadir değildir ve ayırıcı tanı ve müdahalenin "daha acil" olması nedeniyle dikkat edilmelidir. Yaş gruplarına göre bu "daha acil" durumların farkında olunması komplikasyonları, morbiditeyi ve hatta mortaliteyi önleyebilir.

Anahtar Kelimeler

karın, akut, intususepsiyon, adneksiyal torsiyon, barsak tıkanıklığı

Kaynakça

• Refereans1 Duman M, Yılmaz D, Akgül F et al. Çocuk Acil Servisine Akut Karın Ağrısı ile Başvuran Olgularda Klinik Bulguların Yeri. CAYD 2015;2(2):77-82.
• Referans2 Stringer MD. Acute appendicitis. J Paediatr Child Health 2017 Nov;53(11):1071-6.
• Referans3 Balachandran B, Singhi S, Lal S. Emergency management of acute abdomen in children. Indian J Pediatr 2013 Mar;80(3):226-34.
• Referans4 Taşar S, Taşar MA, Güçer L et al. The importance of the history and laboratory tests in the differential diagnosis of acute abdominal pain cases in the pediatric emergency department Turkish J Pediatr Dis 2015; 1: 27-31.
• Referans5 Tekgündüz SA, Şengül A, Biçer S et al. Çocuk acil servisine akut karın ağrısı yakınmasıyla getirilen olguların analizi. Bakırköy Tıp Dergisi 2005;1(2), 52 - 56.
• Referans6 Ilce Z, Yildiz T, Isleyen M. The role of laparoscopy in suspicious abdomen pain in children. Pak J Med Sci 2013 Jul;29(4):1042-5.
• Referans7 Hijaz NM, Friesen CA. Managing acute abdominal pain in pediatric patients: current perspectives. Pediatric Health Med Ther 2017 Jun 29;8:83-91.
• Referans8 Hegde S, Bawa M, Kanojia RP et al. Pediatric trauma: management and lessons learned. J Indian Assoc Pediatr Surg 2020 May-Jun;25(3):142-6.
• Referans9 Lynch T, Kilgar J, Al Shibli A. Pediatric abdominal trauma. Curr Pediatr Rev 2018;14(1):59-63.
• Referans10 Arslan S, Okur MH, Arslan MS et al. Management of gastrointestinal perforation from blunt and penetrating abdominal trauma in children: analysis of 96 patients. Pediatr Surg Int 2016 Nov;32(11):1067-1073.
• Referans11 Glass CC, Rangel SJ. Overview and diagnosis of acute appendicitis in children. Semin Pediatr Surg 2016 Aug;25(4):198-203.
• Referans12 Yang WC, Chen CY, Wu HP. Etiology of non-traumatic acute abdomen in pediatric emergency departments. World J Clin Cases 2013 Dec 16;1(9):276-84.
• Referans13 El Hasbaoui B, Karboubi L, Benjelloun BS. The role of abdominal ultrasound in the management of excessive crying in infants. Pan Afr Med J 2018 May 28;30:68.
• Referans14 Naffaa L, Barakat A, Baassiri A et al. Imaging acute non-traumatic abdominal pathologies in pediatric patients: A pictorial review. J Radiol Case Rep 2019 Jul 31;13(7):29-43.
• Referans15 Sakita FM, Sawe HR, Mwafongo V et al. The burden and outcomes of abdominal pain among children presenting to an emergency department of a tertiary hospital in Tanzania: A Descriptive Cohort Study. Emerg Med Int 2018 May 9;2018:3982648.
• Referans16 Kuppermann N, O'Dea T, Pinckney L et al. Predictors of intussusception in young children. Arch Pediatr Adolesc Med 2000 Mar;154(3):250-5.
• Referans17 Tander B, Baskin D, Candan M et al. Ultrasound guided reduction of intussusception with saline and comparison with operative treatment. Ulus Travma Acil Cerrahi Derg 2007 Oct;13(4):288-93.
• Referans18 Özcan R, Hüseynov M, Emre Ş et al. A review of intussusception cases involving failed pneumatic reduction and re-intussusception. Ulus Travma Acil Cerrahi Derg 2016 May;22(3):259-64.
• Referans19 Pindyck T, Parashar U, Mwenda JM, et al. Risk factors associated with increased mortality from intussusception in African infants. J Pediatr Gastroenterol Nutr 2020;70(1):20–4.
• Referans20 Palanivelu C, Rangarajan M, Shetty AR et al. Intestinal malrotation with midgut volvulus presenting as acute abdomen in children: value of diagnostic and therapeutic laparoscopy. J Laparoendosc Adv Surg Tech A 2007 Aug;17(4):490-2.
• Referans21 Olesen CS, Mortensen LQ, Öberg S et al. Risk of incarceration in children with inguinal hernia: a systematic review. Hernia. 2019 Apr;23(2):245-54. Referans22 Zamakhshary M, To T, Guan J et al. Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. CMAJ 2008 Nov 4;179(10):1001-5.
• Referans23 Tseng YC, Lee MS, Chang YJ et al. Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol 2008 Aug;49(4):126-34.
• Referans24 Adeyemi-Fowode O, McCracken KA, Todd NJ. Adnexal Torsion. J Pediatr Adolesc Gynecol 2018 Aug;31(4):333-8.
• Referans25 Smorgick N, Nir O, Pekar-Zlotin M et al. Long-term ultrasound follow-up after pediatric adnexal torsion. Ultraschall Med 2020 Aug;41(4):404-9.
• Referans26 Demi̇rel BD, Hancıoglu S , Bi̇cakci̇ U et al. Complications of Meckel’s diverticulum in children: A 10-years experience . Journal of Experimental and Clinical Medicine 2020;36(3): 67-71 .
• Referans27 Lin LH, Lee CY, Hung MH et al. Conservative treatment of adhesive small bowel obstruction in children: a systematic review. BMJ Open 2014 Sep 15;4(9):e005789.
• Referans28 Rothstein DH, Harmon CM. Gallbladder disease in children. Semin Pediatr Surg 2016;25(4):225‐31.
• Referans29 Hua MC, Kong MS, Lai MW et al. Perforated peptic ulcer in children: a 20-year experience. J Pediatr Gastroenterol Nutr 2007 Jul;45(1):71-4.