DIFFERENTIAL DIAGNOSIS OF APPENDICITIS AND HAEMATOCOLPOS

Department of pediatric surgery

Submitted by,

Al auf Jalaludeen

ACUTE APPENDICITISAcute appendicitis is the inflammation of the vermiform appendix. It is the most common condition in childhood requiring emergency surgery.

In contrast to adults, children suffer more severe course of appendicitis and the diagnosis is much more difficult.

Due to functional immaturity of the nervous system at this age, almost all acute inflammatory disease have similar picture like, high body temperature, repeated vomiting, intestinal malfunction.

• The inflammatory process in the vermiform appendix in the child is very violent, while the mechanism of its demarcation are very weak.

• Specific difficulties in examination of infants exist restlessness, crying and resistance to the examination make it difficult to detect the main local signs of acute appendicitis.

• The rare occurrence of appendicitis in children under the age of 12 months is explained by specific features of the anatomical structures of their appendix (absence of stasis of the intestinal contents) and the character of diet at this age.

• There is no specific causative agent of acute appendicitis.

• The microflora proper of the vermiform process and intestine plays the leading role in the development of inflammation.

Bacterial pathogenesis: Escherichia coli, streptococcus, pseudomonas, klebsiella, clostridium, bacterioides fragilis, etc

The infection may arrive by the hematogenous and lyphogenous route.

CLASSIFICATION simple

- catarral

destructive

- purulent

- gangrenous

- perforated

complicated

- infiltration

- abscess

CLINICAL SIGNS• Constant abdominal pain in the right lower quadrant.

• Anorexia

• Nausea

• Vomiting

• Constipation

• High temperature

CLINICAL SYMPTOMS• Filatov- strenghthening of pain by palpation in the lower right quadrant

• Kocher- transferring of pain from the epigastrium to the right lower quadrant

• Guarding- muscle tension in the right lower quadrant

• Shotkin- Blumberg- deep abdominal palpation with sudden withdrawal of the examination hand causes pain

• Sitkovsky- strengthening of pain in the right lower quadrant when the turn of trunk on the left side is going on

• Bartomier Michelson- tenderness by palpation of caecum is growing up when the patient is on his left side

• Razdolsky- rebound tenderness by palpation in the right lower quadrant

DIAGNOSIS• History (onset of symptom, pathological sighs)

• Patients position on the bed

• Palpation of symmetrical abdominal quadrants

• Rectal examination

• Laboratory investigation

• Ultrasound examination

• Electromyography

• Laparoscopy

• X-ray examination

DIFFERENTIAL DIAGNOSIS• The differential diagnosis between acute appendicitis and hematocolpos is very

important because, it allows unnecessary appendectomy to be avoided in some cases and true cause of abdominal pain.

• Haematocolpos is an abnormality of the hymenal caruncle of female, which is caused due to failure of disintegration of the central cells of the mullerian eminence the projects into the urogenital sinus.

• It is usually noticed in girls after the age of 14-16 years.

• It is a congenital pathology of female genitals. It may cause abdominal syndrome.

• As the uterus is functioning normally, the menstrual blood is pent up inside the vagina behind the hymen.

• As the uterus is functioning normally, the menstrual blood is pent up inside the vagina behind the hymen.

• Meslowly with parnstural blood accumulates in the vagina and sometimes in the uterus due to congenital absence of natural orifice in the hymen called hymen imperforatus.

• The disease usually starts with paroxysmal abdominal pain,weakness indisposition and headache.

CLINICAL SIGNS• Subfebrile fever

• Nausea

• Vomiting

• Pain (cyclic character and reoccurs every month for a year)

• Medical history supplies information on complete absence of menstruation

• Objective examination reveals an imperforated hymen which bulges out like a dome

• Tumor like structure is detected in the lower abdomen by recto-abdominal examination

TREATMENT• Surgical removal of vermiform appendix

• Analgesics

• Antibiotics

• Disintoxication therapy

• Symptomatic treatment