Estado atual do diagnóstico e tratamento da apendicite aguda na criança: avaliação de 300 casos

• Autor(a) principal: Vital Junior, Pedro Felix [UNIFESP]
• Data de Publicação: 2005
• Outros Autores: Martins, Jose Luiz [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0100-69912005000600005; http://repositorio.unifesp.br/handle/11600/2833
• topic: Appendicitis; Abdomen; acute; Diagnosis techniques; digestive system; Complications; Child; Apendicite; Doença aguda; Abdome agudo; Técnica de diagnóstico do sistema digestório; Complicações; Criança; Appendicitis

BACKGROUND: In our clinical practice, we have observed that despite the great technological advances in diagnostic methods acute appendicitis still represents a problem in children, resulting in late diagnosis and treatment, and case of greater severity. Our objective is to assess the current state of diagnosis and treatment of acute appendicitis in children treated in two important referral hospitals of São Paulo (Brazil), over a 30 month's period. METHODS: The variables studied were: age, sex, clinical manifestations, time for the diagnosis to be established, the findings from physical examination and laboratory tests, surgical findings and antibiotic protocols, postoperative complications and hospital lenght of stay. RESULTS: In the present sample, of 300 children, 65% were boys and 35% girls, with an initial diagnosis of appendicitis being made in 63% of the cases. The signs and symptoms most frequently encountered were: abdominal pain in the right iliac fossa (85.3%) and peritoneal irritation in this region (82%). We identified leukocytosis in 83% of the patients and the urine analysis showed leukocyturia in 39.7% of the patients. Around 92.4% of the simple radiological studies of the abdomen produced images that were not specific to acute appendicitis. Ultrasonography studies diagnosed the disease in 80.1% of the cases. Various antibiotic schemes were used, although there was special attention towards Gram-negative and anaerobic bacteria. The main complication was infection of the surgical wound, and there was no mortality. The average hospital length of stay was 5 days. CONCLUSION: In spite of greater knowledge of acute appendicitis and greater refinement of laboratory and radiological techniques, the diagnosis is still delayed and disease constitutes a cause of great morbidity among pediatric age groups.