| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je proučiti kliničke znakove i ishode liječenja djece mlađe od pet godina u kojih je učinjena apendektomija zbog akutnog apendicitisa.
Ispitanici i metode: Od 1. siječnja 2009. do 31. prosinca 2018. godine, 90 bolesnika mlađih od pet godina u kojih je učinjena apendektomija uključeni su u ovu studiju. Bolesnici su podijeljeni u dvije skupine, ovisno o intraoperacijskom nalazu neperforiranog (Skupina I; n=32) ili perforiranog apendicitisa (Skupina II; n=58). Skupine smo usporedili obzirom na demografske, kliničke i laboratorijske podatke te ishode liječenja (duljina hospitalizacije, učestalost poslijeoperacijskih komplikacija i reoperacija).
Rezultati: Od ukupno 1687 apendektomija u promatranom razdoblju, 90 (5,3%) ih je izvedeno u djece mlađe od pet godina. Bilo je 58 (64,4%) bolesnika s perforiranim apendicitisom. Pronađena je korelacija između učestalosti perforacije i dobi bolesnika. Učestalost perforacije bila je najveća u najmlađih bolesnika (100% <1 godine; 100% 1-2 godine; 83,3% 2-3 godine; 71,4% 3-4 godine; 78,6% 4-5 godina i 47,3% 5 godina) (P=0,037). Najzastupljeniji simptomi bili su bol (100%), anoreksija (80%), mučnina i povraćanje (67,8%), dijareja (33,3%) i konstipacija (25,6%). Povraćanje i dijareja bili su značajno češći u bolesnika s perforiranim apendicitisom (P<0,002; P<0,001), dok je konstipacija bila izraženija u bolesnika s neperforiranim apendicitisom (P<0,001). Medijan duljine trajanja simptoma (48 sati i 16 sati; P<0,001) i medijan duljine hospitalizacije (7,5 i 5 dana; P<0,001) su bili značajno dulji u bolesnika iz skupine perforiranih u odnosu na bolesnike iz skupine neperforiranih apendicitisa. Poslijeoperacijske komplikacije zabilježene su samo u skupini perforiranih apendicitisa i to s učestalošću od 4,4%.
Zaključci: Klinička prezentacija akutnog apendicitisa u ovoj dobnoj skupini može biti atipična te stoga nije rijetka inicijalno pogrešno postavljena dijagnoza. Dob bolesnika je u direktnoj korelaciji sa stadijem bolesti pa se mlađa djeca prezentiraju s uznapredovalom kliničkom slikom i u većem su riziku za perforaciju crvuljka. Akutni apendicitis bi trebalo uzeti u obzir u svakog djeteta koje ima abdominalnu bol, vrućicu i dijareju, za koju je dokazano da je značajno češće prisutna u djece s perforiranim apendicitisom. |
| Abstract (english) | Objectives: The aim of this study is to evaluate the clinical signs and outcomes of treatment in children younger than five years of age who underwent appendectomy because of acute appendicitis.
Patients and methods: From January 1st 2009 until December 31st 2018, 90 patients (54 boys and 36 girls) younger than five years of age who underwent appendectomy at the Department of pediatric surgery, University hospital of Split were included in retrospective study. Patients were divided into two groups, depending on the intraoperative finding of non-perforated (Group I; n=32 patients) or perforated (Group II; n=58 patients) appendicitis. The groups were compared regarding demographic, clinical and laboratory data and outcomes of treatment (the length of hospitalization, the frequency of postoperative complications and reoperations).
Results: Out of 1687 appendectomies in this period, 90 (5.3%) of them were performed in patients younger than five years of age. There were 58 (64.4%) patients with perforated appendicitis. Positive correlation between the rate of perforation and age of patients was found. Perforation rates were significantly higher in younger patients (100% <1 year; 100% 1-2 years; 83.3% 2-3 years; 71.4% 3-4 years; 78.6% 4-5 years and 47.3% 5 years) (P=0.037). Main presenting symptoms were pain (100%), anorexia (80%), nausea/vomiting (67.8%), diarrhoea (33.3%) and constipation (25.6%). Vomiting and diarrhoea were more commonly found in the group of perforated appendix (P<0.002, P<0.001), while constipation was more often found in the group of non-perforated appendicitis (P<0.001). The median duration of symptoms (48 vs. 16 h; P<0.001) and median length of hospital stay (7.5 vs 5 days; P<0.001) were significantly higher in the group of perforated than in the group of non-perforated appendicitis. All complications occurred in group of perforated appendicitis with total incidence of 4.4%.
Conclusion: The clinical presentation of acute appendicitis in this age group may be atypical and initial misdiagnosis is not so rare. Age has a direct correlation to the stage of disease so the youngest children are presented with more advanced appendicitis and are in the greater risk of perforation. Acute appendicitis should be considered in case any child is presenting with abdominal pain, fever and diarrhoea, which has been shown present significantly more often in children with perforated appendix. |
