ADOPA
Publicado: 08/30/2024
DOI: https://doi.org/10.58994/adopa.v2i2.41
Plastrón apendicular en población pediátrica: serie de casos
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Resumen
Appendiceal phlegmon is a presentation of perforated appendicitis that involves structures adjacent to the appendix, including the vast majority of cases and loops of small intestine, making its diagnosis challenging and generating controversy regarding management in the pediatric population. In the following review, a series of five cases are presented at a level IV hospital, all of which are pediatric patients aged between 4 and 17 years, who attended the emergency department from September 2022 to May 2023. The presented clinical cases have a mean age of 11 years (SD: 6.22). Wich they presented abdominal symptoms for approximately 8.6 days (SD: 6.06) before seeking medical attention. The main clinical symp- toms include right lower abdominal pain, fever, and vomiting. The total length of hospital stay varied for each patient with an average of 6.8 days (SD: 1.79). The total duration of anti- biotic administration was 20.2 (SD: 1.64) days. As for surgery, in all cases, initial treatment with antibiotics was chosen, followed by scheduled outpatient appendectomy, without any case of mortality.
Abstract
Appendiceal phlegmon is a presentation of perforated appendicitis that involves structures adjacent to the appendix, including the vast majority of cases and loops of small intestine, making its diagnosis challenging and generating controversy regarding management in the pediatric population. In the following review, a series of five cases are presented at a level IV hospital, all of which are pediatric patients aged between 4 and 17 years, who attended the emergency department from September 2022 to May 2023. The presented clinical cases have a mean age of 11 years (SD: 6.22). Wich they presented abdominal symptoms for approximately 8.6 days (SD: 6.06) before seeking medical attention. The main clinical symp- toms include right lower abdominal pain, fever, and vomiting. The total length of hospital stay varied for each patient with an average of 6.8 days (SD: 1.79). The total duration of anti- biotic administration was 20.2 (SD: 1.64) days. As for surgery, in all cases, initial treatment with antibiotics was chosen, followed by scheduled outpatient appendectomy, without any case of mortality.
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Referencias
Ayala Ledesma ME. Aspectos clínico-epidemiológicos y manejo del plas- trón apendicular en pacientes pediátricos atendidos en el Servicio de Cirugía del Instituto Nacional de Salud del Niño durante el periodo enero 2004 - diciembre 2008 [tesis]. Lima, Perú: Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Unidad de Post Grado; 2011. Disponible en: https://hdl.handle.net/20.500.12672/2029
Delgado Garro AM, Cehua Alvarez EA, Virú Flores HM, Roque Quezada JC, Valdiglesias Ochoa DJ, Nieves Cordova LE et al. Características epide- miológicas-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú. Rev. Fac. Med. Hum. [Internet]. 2023;23(1):79-86. Disponible en: http://www.scielo.org. pe/scielo.php?script=sci_arttext&pid=S2308-05312023000100079& lng=es
Puri P, Hôllwarth M. Appendicitis in Pediatric Surgery. Springer Dordrecht Heidelberg London New York; 2009.
Camacho-Cruz J, Padilla PO, Sánchez DG, et al. Outcomes of acute appen- dicitis in patients younger than age 4: a descriptive study. Ann Pediatr Surg. 2022;18:59. Disponible en: https://doi.org/10.1186/s43159-022-00196-x
Puri P, Boyd E, Guiney EJ, O´Donnell B. Appendix mass in very young child. J Pediatr Surg. 1981;16:55-7.
Gillick J, Velayudham M, Puri P. Conservative management of appendix mass in children. Br J Surg. 2001;88:1539-42.
Núñez D, Huber J. Nonsurgical drainage of appendiceal abscesses. AJR. 1986;146:587-9.
Price M, Haase G. Recurrent appendicitis after initial conservative mana- gement of appendiceal abscess. J Pediatr Surg. 1996;31:291-4.
Brainsky A, Salamanca E, Bonilla E, Varón C, Roa JL, Díaz D. Controversias en el manejo del plastrón y el absceso apendicular: reporte de un caso. Rev Colomb Cir. 2004 Sep;19(3):190-4. Disponible en: http://www.scielo.org.co/ scielo.php?script=sci_arttext&pid=S2011-75822004000300009&lng=en
Gillick J, Velayudham M, Puri P. Conservative management of appendix mass in children. Br J Surg. 2001;88:1539-42.
Gahukamble DB, Gahukamble LD. Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children. J Pediatric Surg. 2000;35:424-7.
Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr. 2017;43:1-9. Disponible en: https://doi.org/1 0.1186/s13052-017-0335-2.
Bonadio W, Peloquin P, Brazg J, Scheinbach I, Saunders J, Okpalaji C, et al. Appendicitis in preschool aged children: regression analysis of factors associated with perforation outcome. J Pediatr Surg. 2015;50(9):1569-73. Disponible en: https://doi.org/10.1016/j.jpedsurg.2015.02.050.
Henry MC, Gollin G, Islam S, Sylvester K, Walker A, Silverman BL, Moss RL. Matched analysis of nonoperative management vs immediate appen- dectomy for perforated appendicitis. J Pediatr Surg. 2007;42(1):19-24. doi: 10.1016/j.jpedsurg.2006.09.005.
van Amstel P, Sluckin TC, van Amstel T, van der Lee JH, de Vries R, Derikx JPM, Bakx R, van Heurn LWE, Gorter RR. Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treat- ment? A systematic review and meta-analysis. Surg Endosc. 2020;34(12): 5234-49. doi: 10.1007/s00464-020-07822-y.
Van Rossem CC, Bolmers MDM, Schreinemacher MHF, van Geloven AAW, Bemelman WA. Prospective nationwide outcome audit of surgery for suspected acute appendicitis. Br J Surg. 2016;103(1):144-51. doi: 10.1002/ bjs.9964.
Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis compa- ring conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon) Surgery. 2010;147(6),818-29. doi: 10.1016/j. surg.2009.11.013.
Van Rossem CC, van den Boom AL, Boom WJ, Boss ME, van Geloven AAW, Gorter RR, Jacod BC, Knaapen M, Lammers R, van Meurs AHJ, Nederend J, Puylaert JBCM. Startpagina - Acute appendicitis - Richtlijn - Richtlijnen- database. [Guideline database website Richtlijnendatabase.nl]. July 1, 2019. Available at: https://www.ntvg.nl/artikelen/herziene-richtlijn-over-acu- te-appendicitis#
Tanaka Y, Uchida H, Kawashima H, Fujiogi M, Suzuki K, Takazawa S, Deie K, Amano H, Iwanaka T. More than one-third of successfully nonopera- tively treated patients with complicated appendicitis experienced recu- rrent appendicitis: Is interval appendectomy necessary? J Pediatr Surg. 2016;51(12):1957-61. doi: 10.1016/j.jpedsurg.2016.09.017.
St. Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW, Leys CM, Murphy JP, Snyder CL, Sharp RJ, Andrews WS, Holcomb GW, 3rd, Ostlie DJ. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a pros- pective, randomized trial. J Pediatr Surg. 2010;45(1):236-40. doi: 10.1016/j. jpedsurg.2009.10.039.
Fugazzola P, Coccolini F, Tomasoni M, Stella M, Ansaloni L. Early appen- dectomy vs. conservative management in complicated acute appendicitis in children: a meta-analysis. J Pediatr Surg. 2019; 54(11):2234-41 doi: 10.1016/j. jpedsurg.2019.01.065.
Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conser- vative treatment for complicated acute appendicitis in children? A meta- analysis. J Pediatr Surg. 2019;54(7):1365-71. doi: 10.1016/j.jpedsurg.2018. 07.017.
Cheng Y, Xiong X, Lu J, Wu S, Zhou R, Cheng N. Early versus delayed appen- dicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2017;6(6):CD011670. doi: 10.1002/14651858.CD011670.pub2.
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