Journal of Developmental Medicine(Electronic Version)  2020, Vol. 8 Issue (1): 72-76 DOI: 10.3969/j.issn.2095-5340.2020.01.013 |
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| Clinical analysis of four cases with acute appendicitis in premature infants and literature review |
| ZHU Li-min, ZHANG Yan-ping, KONG Xiang-yong,et al
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Neonatal Intensive Care Unit of Bayi Children's Hospital, Seventh Medical Center of PLA General Hospital, Beijing,
100700, China |
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Abstract 【Abstract】 Objective To explore the clinical characteristics, experience of diagnosis and treatment of acute appendicitis in premature infants, in order to improve the awareness and the treatment rate. Methods The clinical data of four cases with acute appendicitis in preterm infants who were admitted to neonatal intensive care unit of Bayi Children's Hospital, Seventh Medical Center of PLA General Hospital were retrospectively analyzed and summarized. The clinical data included clinical manifestations, early diagnosis, and intraoperative diagnosis. Relevant literatures searched from Wanfang, CNKI, Weipu,
PubMed and other databases were reviewed and analyzed. Results ① Cases report: four cases in this article had "bloating" as the first symptom, and the inflammatory index increased significantly. They were given emergency surgery. All infants were diagnosed as acute appendicitis during operation. Two of them were simple acute appendicitis and the other two were neonatal necrotizing enterocolitis (NEC). Afterthe operation, all the four infants were treated with anti-infection and fluid rehydration, finally cured and discharged. ② Literature review: eight Chinese literatures and 10 English literatures of acute appendicitis in
premature infants were retrieved from the Chinese databases and PubMed database. The literatures on acute appendicitis of premature infants in the past 30 years at home and abroad were few. The literatures were mainly divided into case report and misdiagnosis analysis. Among them, the eight Chinese literatures totally reported 35 cases of acute appendicitis in preterm infants, 27 cases of male and 7 cases of female, and one literature did not describe gender; 32 cases of perforated, one case of unperforated, one case of appendicitis with intestines, and the other was inguinal incarcerated hernia. One infant died （2.9%）and the rest were cured by active surgery. The 10 foreign literatures totally reported 11 cases of acute appendicitis in premature
infants, 9 cases of male and 2 case of females, 5 cases of perforation, 2 cases of sepsis, 1 case of blood stool, 3 cases of inguinal hernia, and no death. In 11 cases, no acute appendicitis was diagnosed in the early stage, and all were diagnosed postoperatively. Conclusions There is no specific clinical manifestation of acute appendicitis in premature infants. The rate of misdiagnosis is high. Preoperative diagnosis is difficult. It needs to be combined with abdominal examination, X-ray, B-ultrasound or laparotomy. Early surgical exploration should be carried out to reduce mortality as soon as the disease is clinically suspected.
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Received: 14 October 2019
Published: 23 January 2020
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