Appendicitis in children. Evaluation Protocol.
Hesham M. Farouk, Tohamy H. Elkholy and Tarek A Khatab**
Radiology Department, Faculty of Medicine, Banha University, Pediatric** Department, Faculty of Medicine, Banha University,
Abstract:
Introduction: Improvement of the preoperative diagnosis of acute appendicitis in children is the goal of many studies. We are trying to create an evaluation protocol with clinical and ultrasonographic criteria starting from medical history, clinical examination, laboratory investigation and ultrasonographic imaging.
Patients and methods: 151 children with a mean age of 9.3 years (+/- 1.1 Yrs) referred to emergency room with acute abdominal pain were underwent to clinical, laboratory and ultrasonographic imaging protocol.
Results: Sixty nine children with a mean age of 9.3 years (+- 1.1 y) had appendicitis (operated). Fifty of these children (72.4 %) were diagnosed with certainty based on history, clinical examination, laboratory investigation and ultrasound imaging. The remaining 28 child still doubt full. This group (24.3 %) of patients received water enema and intravenous fluid (Ringer lactate 4m/kgm/h) for more hydration and less gases. Then subjected to 2nd clinical and ultrasound evaluation after approximately 4 hours observation. The percentage of correctly diagnosed appendicitis could b e increased up to 96.5 %
Conclusion: In order to improve the preoperative diagnosis and operative outcome for acute appendicitis in children, combined careful clinical and ultrasonographic evaluation is advised. Repeated examination with short period of dynamic observation can increase the accuracy of diagnosis in equivocal cases.