Skip to main content

Akute Appendizitis

  • Chapter
  • First Online:
Book cover Akutes Abdomen im Kindes- und Jugendalter
  • 1712 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

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

    Article  Google Scholar 

  • Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15(5):557–564

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Birnbaum B, Wilson S (2000) Appendicitis at the millennium. Radiol 215:337–348

    Article  CAS  Google Scholar 

  • 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

    CAS  Google Scholar 

  • 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Colvin J, Bachur R, Kharbanda A (2007) The presentation of appendicitis in preadolescent children. Pediatr Emerg Care 23:849–855

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Doraiswamy N (1979) Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. Br J Surg 66(11):782–784

    Article  CAS  PubMed  Google Scholar 

  • Doria A (2009) Optimizing the role of imaging in appendicitis. Pediatr Radiol 39:144–148

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Eryilmaz R, Sahin M, Savas M (2004) Is interval appendectomy necessary after conservative treatment of appendiceal masses? Ulus Travma Derg 10(3):185–188

    Google Scholar 

  • Fishman S, Pelosi L, Klavon S, O’Rourke E (2000) Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg 35:923–926

    Article  CAS  PubMed  Google Scholar 

  • Flum D, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137:799–804

    Article  PubMed  Google Scholar 

  • Friedland J, Siegel M (1997) CT appearance of acute appendicitis in childhood. Am J Roentgenol 168:439–442

    Article  CAS  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Gillick J, Velaydham M, Puri P (2001) Conservative management of appendix mass in children. Br J Surg 88:1539–1542

    Article  CAS  PubMed  Google Scholar 

  • Gillick J, Mohanan N, Das L, Puri P (2008) Laparoscopic appendectomy after conservative management of appendix mass. Pediatr Surg Int 24:299–301

    Article  CAS  PubMed  Google Scholar 

  • Green R, Bulloch B, Kabani A et al (2005) Early analgesia for children with acute abdominal pain. Pediatr 116:978–983

    Article  Google Scholar 

  • Janik J, Ein S, Shandling B et al (1980) Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg 15:574–576

    Article  CAS  PubMed  Google Scholar 

  • Jeffrey RB Jr, Laing FC, Townsend RR (1988) Acute appendicitis: sonographic criteria based on 250 cases. Radiol 167:327–329

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Kaiser S, Frenckner B, Jorulf H (2002) Suspected appendicitis in children: US and CT – a prospective randomized study. Radiol 223(3):633–638

    Article  Google Scholar 

  • Kaneko K, Tsuda M (2004) Ultrasound based decision making in the treatment of acute appendicitis in children. J Pediatr Surg 39:1316–1320

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Kutasy B, Puri P (2013) Appendicitis in obese children. Pediatr Surg Int 29:537–544

    Article  PubMed  Google Scholar 

  • Kwok M, Kim M, Gorelick M (2004) Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 20(10):690–698

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Nance M, Adamson W, Hedrick H (2000) Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 16(3):160–162

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Puapong D, Lee S, Haigh P et al (2007) Routine interval appendectomy in children is not indicated. J Pediatr Surg 42(9):1500–1503

    Article  PubMed  Google Scholar 

  • Puylaert J (1986) Acute appendicitis: US evaluation using graded compression sonography. Radiol 158:355–360

    Article  CAS  Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • Rentea RM, Peter SDS, Snyder CL (2017) Pediatric appendicitis: state of the art review. Pediatr Surg Int 33:269–283

    Article  PubMed  Google Scholar 

  • Rothrock S, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36(1):39–51

    Article  CAS  PubMed  Google Scholar 

  • Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Surana R, Quinn F, Puri P (1993) Is it necessary to perform appendicectomy in the middle of the night in children? BMJ 306:1168

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Teece S (2012) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Emerg Med J 29:422–423

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • Visnjic S (2008) Transumbilical laparoscopically assisted appendectomy in children. High-tech low-budget surgery. Surg Endosc 22:1667–1671

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Ware D, Huda W, Mergo P et al (1999) Radiation effective doses to patients undergoing abdominal CT examinations. Radiol 210:645–650

    Article  CAS  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Günter Fasching .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-55995-6_17

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55994-9

  • Online ISBN: 978-3-662-55995-6

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics