급성 위장관염양상으로 입원한 소아 급성 충수염환자에 대한 임상적 고찰

Abstract

Purpose: Appendicitis is the most common disease requiring emergent abdominal surgery in children. There have been serious complications in cases of delayed presentation or misdiagnosis. Appendicitis looking like acute gastroenteritis has been notorious for a leading cause of them, but there were little investigation about it in Korea. So I investigated its clinical characteristics to improve the management.

Methods: I collected the clinical informations of patients under 15 years old who have admitted with initial impression as acute gastroenteritis and received appendectomy for appendicitis from January 2001 to December 2007 at YongIn severance Hospital, YongIn, Korea. Their features such as age, sex, symptom at admission, clinical clues to suspect appendicitis, presence of perforation were studied retrospectively.

Results: Their were twelve cases. The proportion of it was 0.4% of acute gastroenteritis and 5.4% of acute appendicitis. Eight (66.7% of cases) were occurred from September to February. The male to female ratio was 1.4:1. Eleven (91.7%) were under 3 years old. Fever (100.0% of cases), diarrhea (100.0%), irritability (83.3%), abdominal pain (66.7%), vomiting (66.7%) were observed at first manifestation. The clues leading to suspect it were abdominal distension (83.3%), rigidity (83.3%), further increased total and neutrophil counts of white blood cell (75.0%, 66.7%), prolonged fever (50.0%), and vomiting (25.0%). Eleven cases (91.7%) were perforated.

Conclusion: It was rare, but showed high morbidity. Appendicitis should be considered in children under 3 years old whose their initial clinical findings liked acute gastroenteritis when abdominal distension, rigidity and not responding to the conservative management were observed.