Appendicitis in Children Younger Than 3 Years of Age: An 18-Year Experience

雖然發生於三歲以下幼童的闌尾炎並不常見，但手術時通常已經穿孔，手術後常常伴隨許多併發症。我們分析過去的經驗並探討延遲診斷的原因。過去的十八年共有九位三歲以下幼童，其中四位在症狀發生48小時內就被送到本院急診，另外五位的症狀持續超過48小時，不過在手術時，所有的闌尾都已穿孔。一旦症狀持續超過兩天，發燒、腹脹和腹瀉等症狀常合併出現。通常症狀持續超過48小時才被正確診斷的病童年紀更小、發炎指數明顯升高、手術所需的時問和住院的天數明顯增加。雖然沒有病童在手術過程中死亡，但其中七位出現術後的併發症，貧血和傷口感染是最常見的兩個問題。因為發生率低、症狀不明確，延遲診斷並非少見，因此徹底了解闌尾炎穿孔之後的病程是很重要的。發燒、腹瀉和腹脹通常是闌尾穿孔晚期的表現。若因此能早期手術，則可降低手術後的併發症、縮短手術所需的時间和住院的天數。

關鍵字

急性闌尾炎；幼童；穿孔性闌尾炎

並列摘要

Appendicitis in children younger than 3 years of age has always been of concern due to its low incidence and high perforation rate. In this study, we analyzed our experience and evaluated the factors contributing to the delay in diagnosis. During the last 18 years, there were nine children younger than 3 years of age who presented with appendicitis. Four of these patients visited our emergency department within 48 hours after the onset of symptoms, while the symptoms had already persisted for more than 48 hours in the remaining five patients before their arrival in our emergency department. Perforated appendicitis was found in all children. Once the perforation had occurred for more than 2 days, complaints of fever, abdominal distention, and diarrhea were common. Compared to patients with symptoms for less than 2 days, those with symptoms for more than 2 days were younger and had higher serum C-reactive protein levels, significantly longer operation time, duration of postoperative ileus and length of hospital stay (LOS) (p=0.026, 0.014, 0.018, and 0.014, respectively). No mortality was noted in the entire series, but seven of the nine patients had one or more complications, which may have prolonged LOS; anemia and wound infections were the two most common problems. Since delayed diagnosis is common, a thorough understanding of the clinical course of perforated appendicitis is important. Fever, diarrhea, and abdominal distention seem to be late manifestations. Prolonged LOS, operation time, and postoperative complications may be reduced if the operation is performed earlier.

並列關鍵字

acute appendicitis ； children ； perforated appendicitis

國際替代計量

Appendicitis in Children Younger Than 3 Years of Age: An 18-Year Experience

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