Aggiornamento
L’appendicite acuta nei primi cinque anni di vita:
una sfida per il pediatra
Acute appendicitis under five years of age: a challenge for the paediatrician
Giuseppina Campana1, Pierluigi Marzuillo1, Claudio Germani2, Stefano Guarino3, Ingrid Rabach2, Egidio Barbi2
1Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Seconda Università di Napoli
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
3Nefrologia Pediatrica, Azienda Ospedaliero-Universitaria “Sant’Orsola-Malpighi”, Bologna
Aprile 2016 - pagg. 225 -230
Abstract
Acute appendicitis is one of the most frequent causes of abdominal surgery in paediatric
ages, with the peak incidence in the second decade of life. Acute appendicitis in the
first years of life is an uncommon but not so rare event. The clinical presentation is often
pleomorphic and the diagnosis may be overshadowed by other medical conditions.
Gastroenteritis is the most common misdiagnosis, with a history of diarrhoea present in
33% to 41% of patients. Pain is the most common early symptom in children younger
than 5 years old, followed by vomit, fever, anorexia and diarrhoea. The most common
physical sign is focal tenderness (61.3% of the patients) followed by guarding (54.8%),
diffuse tenderness (38.7%), rebound (32.3%), and mass (6.5%). Neonatal appendicitis
is a very rare disease with high mortality; the early symptoms are non-specific and the
abdominal distension is the main clinical manifestation. As a matter of fact, there is evidence
that the younger is the patient the earlier the perforation occurs: 70% of patients
younger than 3 years old develop a perforation in less than 48 hours from the onset of
the symptoms. The challenge for the paediatrician is to perform a prompt diagnosis of
“acute appendicitis” in order to reduce the risk of complications, mainly early in life. The
paper highlights the epidemiology, pathophysiology, clinical signs and laboratory clues
of appendicitis in younger children and suggests an algorithm for early diagnosis.
Classificazione MeSH
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Corrispondenza: giuseppina.campana86@gmail.com