An analysis of unsatisfactory results of treatment of acute appendicitis in children

Abstract

The issues of diagnosis and treatment of acute appendicitis in children are widely covered in the literature, however, early diagnosis, especially in infants, remains a difficult problem in pediatric surgery. The purpose of the work is to analyze the cases of unsatisfactory results of treatment of various forms of acute appendicitis in children.
Materials and methods. We carried out а retrospective analysis of the diagnosis and treatment of 1034 children who were hospitalized in the department of emergency surgery of Vinnytsia region clinical pediatric hospital in the period from 2015 to 2018 with a diagnosis of acute appendicitis. Of these, 938 children were operated on for various forms of acute appendicitis and their complications. 69 (7.4%) children were operated on for the periappendicular abscess: boys – 42 (61%), girls – 27 (39%).
Results. Over the past 4 years, 76 children have been operated on with complicated forms of acute appendicitis, both for periappendicular abscess and for diverticulitis, ovarian apoplexy, primary peritonitis, torsion of the ovarian cyst. According to our data, the late hospitalization of children with a diagnosis of acute appendicitis in hospital facilities was associated with the economic and social difficulties of the rural and urban population. Underestimation of the general clinical symptoms of acute appendicitis by pediatricians, family medicine doctors and surgeons of district clinics and hospitals. All this led to the tactics of unreasonable observation and conservative treatment with an unknown diagnosis, especially in children of an early age group. It was more difficult to conduct differential diagnosis of acute appendicitis in children with an atypical location of the appendicular process. All these factors led to severe acute complications in children with frequent occurrence of periappendicular abscesses, which amounted to almost 30% of all operated children.
Conclusions. The high incidence of pre-hospital diagnostic errors in children with suspected acute appendicitis necessitates the need to improve the knowledge of emergency care for children of family physicians and general surgeons. The main method for the effective treatment of children with acute appendicitis is to solve the main problems through rational comprehensive treatment in a surgical hospital of a children’s hospital.