Zusammenfassung
Die akute Appendizitis ist die häufigste Abdominalerkrankung bei 5- bis 12-jährigen Kindern. Sie wird wahrscheinlich durch eine mechanisch bedingte Sekretabflussbehinderung aus dem Appendixlumen verursacht. Anamnestisch kommt es neben Übelkeit und Erbrechen zu Schmerzen im mittleren Oberbauch, die sich im Verlauf von Stunden in den rechten Unterbauch verlagern. Typischerweise finden sich ein Druckschmerz und eine Abwehrspannung im rechten Unterbauch. Die Kompressionssonographie des Abdomens ist die radiologische Untersuchungsmethode erster Wahl und sollte bei Mädchen immer zum Ausschluss einer Pathologie des inneren Genitale durchgeführt werden. Therapie der Wahl ist die Appendektomie; sie kann offen, laparoskopisch oder als »Single-port-Appendektomie« durchgeführt werden. Neue Studien ergeben Hinweise, dass bei einer unkomplizierten Appendizitis eine primär nichtoperative Behandlung mit Antibiotika durchgeführt werden kann.
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Literatur
Abularrage C, Bloom S, Bruno D et al (2008) Laparoscopic drainage of postappendectomy-retained fecalith and intra-abdominal abscess in the pediatric population. J Laparoendosc Advan Surg Tech 18(4):644–650
Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15(5):557–564
Anderson RE (2007) The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg 31:86–92
Andersson M, Andersson RE (2008) The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg 32(8):1843–1849
Bachur RG, Levy JA, Callahan MJ et al (2015) Effect of reduction in the use of computed tomography on clinical outcomes of appendicitis. JAMA Pediatr 169(8):755–760
Beltran M, Almonacid J, Vicencio A et al (2007) Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg 42(7):1208–1214
Bendeck S, Nino-Murcia M, Berry G, Jeffrey R Jr (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiol 235(1):131–136
Birnbaum B, Wilson S (2000) Appendicitis at the millennium. Radiol 215:337–348
Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Radiol 176:289–296
Carley S, Mackway-Jones K, Jones A et al (1998) Moving towards evidence based emergency medicine: use of a structured critical appraisal journal club. J Accid Emerg Med 15:220–222
Colvin J, Bachur R, Kharbanda A (2007) The presentation of appendicitis in preadolescent children. Pediatr Emerg Care 23:849–855
Dennett K, Tracy S, Fisher S et al (2012) Treatment of perforated appendicitis in children: what is the cost? J Pediatr Surg 47:1177–1184
Doraiswamy N (1979) Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. Br J Surg 66(11):782–784
Doria A (2009) Optimizing the role of imaging in appendicitis. Pediatr Radiol 39:144–148
Duggan EM, Marshall AP, Weaver KL et al (2016) A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early versus interval appendectomy for children with perforated appendicitis. Pediatr Surg Int 32:649–655
Eryilmaz R, Sahin M, Savas M (2004) Is interval appendectomy necessary after conservative treatment of appendiceal masses? Ulus Travma Derg 10(3):185–188
Fishman S, Pelosi L, Klavon S, O’Rourke E (2000) Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg 35:923–926
Flum D, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137:799–804
Friedland J, Siegel M (1997) CT appearance of acute appendicitis in childhood. Am J Roentgenol 168:439–442
Georgiou R, Eaton S, Stanton MP et al (2017) Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatr 139(3):e20163003
Gorter RR, The SML, Gorter-Stam MAW et al (2017) Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis. J Pediatr Surg 52(8):1219–1227
Gillick J, Velaydham M, Puri P (2001) Conservative management of appendix mass in children. Br J Surg 88:1539–1542
Gillick J, Mohanan N, Das L, Puri P (2008) Laparoscopic appendectomy after conservative management of appendix mass. Pediatr Surg Int 24:299–301
Green R, Bulloch B, Kabani A et al (2005) Early analgesia for children with acute abdominal pain. Pediatr 116:978–983
Janik J, Ein S, Shandling B et al (1980) Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg 15:574–576
Jeffrey RB Jr, Laing FC, Townsend RR (1988) Acute appendicitis: sonographic criteria based on 250 cases. Radiol 167:327–329
Johnson AK, Filippi CG, Andrews T et al (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. Am J Roentenol 198:1424–1430
Kaiser S, Frenckner B, Jorulf H (2002) Suspected appendicitis in children: US and CT – a prospective randomized study. Radiol 223(3):633–638
Kaneko K, Tsuda M (2004) Ultrasound based decision making in the treatment of acute appendicitis in children. J Pediatr Surg 39:1316–1320
Karakas S, Guelfguat M, Leonidas J et al (2000) Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol 30(2):94–98
Kim E, Subhas G, Mittal V, Golladay E (2009) C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. Int J Surg 7:74–77
Kosloske A, Love C, Rohrer J et al (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:9–34
Kutasy B, Puri P (2013) Appendicitis in obese children. Pediatr Surg Int 29:537–544
Kwok M, Kim M, Gorelick M (2004) Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 20(10):690–698
Martin A, Vollman D, Adler B, Caniano D (2004) CT scans may not reduce the negative appendectomy rate in children. J Pediatr Surg 39(6):886–890
Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063
Nadler E, Reblock K, Vaughan K et al (2004) Predictors of outcome for children with perforated appendicitis initially treated with non-operative management. Surg Infect 5(4):349–356
Nance M, Adamson W, Hedrick H (2000) Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 16(3):160–162
Nielsen JW, Boomer L, Kurtovic K et al (2015) Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasound report template. J Pediatr Surg 50(1):144–148
Orth RC, Guillerman RP, Zhang W et al (2014) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiol 272(1):233–240
Otake S, Suzuki N, Takahashi A et al (2014) Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 44:1400–1405
Peña B, Mandl K, Kraus S et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046
Peña B, Taylor G, Fishman S, Mandl K (2002) Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis. Pediatr 110:1088–1093
Peter S, Aguayo P, Fraser J et al (2010) Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 45:236–240
Puapong D, Lee S, Haigh P et al (2007) Routine interval appendectomy in children is not indicated. J Pediatr Surg 42(9):1500–1503
Puylaert J (1986) Acute appendicitis: US evaluation using graded compression sonography. Radiol 158:355–360
Reddan T, Corness J, Mengersen K et al (2016) Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci 63:59–66
Rentea RM, Peter SDS, Snyder CL (2017) Pediatric appendicitis: state of the art review. Pediatr Surg Int 33:269–283
Rothrock S, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36(1):39–51
Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881
Sesia SB, Mayr J, Bruder E, Häcker FM (2013) Neurogenic appendicopathy: clinical, macroscopic, histopathological presentation in pediatric patients. Eur J Pediatr Surg 23(3):238–242
St Peter SD, Sharp SW, Holcomb GW 3rd, Ostlie DJ (2008) An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 43:2242–2245
Stylianos S, Nichols L, Ventura N et al (2011) The »all-in-one« appendectomy: quick, scarless, and less costly. J Pediatr Surg 46:2336–2341
Surana R, Quinn F, Puri P (1993) Is it necessary to perform appendicectomy in the middle of the night in children? BMJ 306:1168
Teece S (2012) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Emerg Med J 29:422–423
Thirumoorthi A, Fefferman N, Ginsburg H et al (2012) Managing radiation exposure in children – reexamining the role of ultrasound in the diagnosis of appendicitis. J Pediatr Surg 47:2268–2272
Tsao K, Peter S, Valusek P et al (2008) Management of pediatric acute appendicitis in the computed tomographic era. J Surg Res 147:221–224
Visnjic S (2008) Transumbilical laparoscopically assisted appendectomy in children. High-tech low-budget surgery. Surg Endosc 22:1667–1671
Wan M, Krahn M, Ungar W et al (2008) Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis – a Markov decision analytic model. Radiology 250:378–386
Ware D, Huda W, Mergo P et al (1999) Radiation effective doses to patients undergoing abdominal CT examinations. Radiol 210:645–650
Warner B, Kulick R, Stoops M et al (1998) An evidenced-based clinical pathway for acute appendicitis decreases hospital duration and cost. J Pediatr Surg 33(9):1371–1375
Wiersma F, Toorenvliet BR, Bloem JL et al (2009) US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol 19(2):455–461
Willemsen P, Hoorntje L, Eddes E et al (2002) The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg 19(3):216–220 (discussion 221)
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Fasching, G., Mayr, J. (2018). Akute Appendizitis . In: Mayr, J., Fasching, G. (eds) Akutes Abdomen im Kindes- und Jugendalter. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55995-6_17
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