l’appendicite nei bambini

 mal di pancia

L’appendicite è un’ infiammazione dell’appendice vermiforme (un sottile tubulo che origina dalla prima porzione del grosso intestino detto intestino cieco) che normalmente è posizionata a livello del quadrante inferiore destro dell’addome. L’appendicite può essere acuta o cronica
L’appendicite acuta si manifesta principalmente tra i 6 e i 20 anni e anche se può presentarsi a tutte le età è meno comune sotto i 4 anni; la sua frequenza è indipendente dal sesso. È  la causa più comune di urgenza chirurgica nell’età pediatrica.
L’appendicite cronica è invece un’infiammazione cronica della appendice, conseguenza di un’appendicite acuta non diagnosticata o non trattata chirurgicamente.  
Cause
L’appendicite è dovuta al moltiplicarsi in modo anomalo di batteri innocui e che normalmente vivono nell’intestino, come Escherichia Coli,Streptococchi e Stafilococchi; la condizione scatenante solitamente è un’ occlusione del lume dell’appendice che causa il ristagno dei batteri e provoca l’infezione.

L’occlusione può avere varie cause: muco raggrumato, noccioli, parassiti, una posizione anomala dell’appendice causata dalla sua eccessiva lunghezza; talora possono essere responsabili anche cibi molto grassi o ricchi di coloranti.
Sintomi
La sintomatologia può essere differente da paziente a paziente a secondo dell’età e della posizione dell’appendice.
La forma tipica è caratterizzata da un forte ed improvviso dolore addominale tipo trafittivi prevalentemente in basso a destra, ma può estendersi a tutto l’addome o dall’ombelico in giù, in casi più rari può interessare la coscia. Il dolore può peggiorare con il movimento, i respiri profondi, la palpazione, la tosse o gli starnuti.
Altri sintomi sono:

–      nausea
–     vomito
–     Febbre non molto alta (37,2 – 38°C) nelle forme iniziali non complicate da peritonite
–     Stitichezza diarrea

–     perdita dell’appetito
–     malessere generale
La diagnosi di appendicite viene fatta principalmente sulla base della visita medica, ma sono d’aiuto esami del sangue (valore dei globuli bianchi, e indici di infiammazione – VES e della proteina C reattiva), l’ecografia dell’addome e, in casi selezionati, la TAC dell’addome con la quale si può distinguere distinguere un dolore di origine appendicolare da un dolore che ha altre cause, oppure evidenziare ascessi o patologie di altri organi.
Complicanze:
L’appendice infiammata può rompersi o perforarsi, causando la contaminazione della cavità addominale da parte di materiale infetto e la conseguente produzione di pus: si parla in questi casi di peritonite. E’ possibile anche l’evoluzione verso l’ascesso appendicolare.
Terapia
La terapia dell’appendicite consiste nell’intervento chirurgico di asportazione dell’appendice (appendicectomia) in anestesia generale.

Dopo l’intervento, il bambino non può bere o mangiare per un periodo di tempo dalle 24 alle 72 ore;  viene reidratato per endovena e spesso trattato con un antibiotico a scopo precauzionale. Quando l’alvo inizia a canalizzarsi (ovvero quando il bambino riprende a scaricarsi) viene consentita prima una dieta idrica e poi solida.  Alla dimissione è indispensabile eseguire delle medicazioni, talora continuare la terapia antibiotica mentre per il bagno o la doccia la ferita deve essersi sia chiusa definitivamente.
Le attività abituali devono riprendere in maniera graduale e l’attività sportiva non prima di 4 o 5 settimane dopo l’intervento.

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