소아 급성 복통 환자에서 외과적 복증과 장간막 림프절염의 임상적 고찰 = Clinical Characteristics of Acute Surgical Abdomen and Mesenteric Lymphadenitis in Children with Acute Abdominal Pain

다국어 초록 (Multilingual Abstract)

Purpose: Acute appendicitis (AP) and mesenteric lymphadenitis (ML) in children is difficult to distinguish because of similar to clinical symptoms and physical examinations, and non-specific findings. The purpose of this study is to find out useful clinical symptoms and signs to differentiation of AP and ML, and to know usefulness of abdominal sonography in children with acute abdominal pain.
Methods: This retrospective study included 185 patients under 18 years old who visit Hanil General Hospital and Kyunghee University Hospital with acute abdominal pain and examined with abdominal sonography from Jan. 2004 to Dec. 2005. Patients were divided 4 groups; group A was ML without associated diseases, group B was ML with associated diseases, group C was AP, group D was other diseases neither ML nor AP.
Results: Group A were 63 patients, group B were 22 patients, group C were 79 patients, group D were 21 patients. The incidence was most prevalent in 6~10 years old both group A and group C. The mean age were 114.2±50 months, 127.1±51.3 months in ML group and AP group respectively. The prevalence of ML was 55% in males and 45% in females. The prevalence of AP was 58% in males and 42% in females. The site of abdominal pain was most frequent in right lower abdomen all of group A, group B and group C. Right lower abdominal tenderness and rebound tenderness were more frequent in acute appendicits group than mesenteric lymphadenitis group (P<0.05). There was no statistical significance in clinical symtoms such as fever, nausea, vomiting and constipation, but recent history of upper respiratory tract infection was more frequent in mesenteric lymphadenitis group than acute appendicitis group (P<0.05). Associated diseases of group B showed five patients of acute gastroenteritis, four patients of acute pharyngotonsillitis, two patients of pneumonia, two patients of intussusception, one patient of tuberculous enteritis, meckel's diverticulum and omphalomesenteric duct cyst, acute otitis media, chronic pyelonephritis, pelvic inflammatory disease, ovarian cyst, urinary tract infection, aseptic meningitis each. In acute appendicitis group, the mean white blood cell's count was more higher than mesenteric lymphadenitis group and was more frequent in 15,000/㎣ over. ESR and CRP values were more high in acute appendicitis group than mesenteric lymphadenitis group (P<0.05). The mean sizes of mesenteric lymph nodes were 10.6±3.7mm(5~21.7mm), 11.3±4.5mm(3~18mm), 9.l±2.5mm(4.5~12.9mm) in group A, group B and group C, respectively, but there was no statistical significance in sizes. Abdominal sonography and computed tomography for detecting acute appendicitis had a positive predictive value of 93.5% and 100%, respectively. Group D showed seven patients of acute gastroenteritis, three patients of acute pyelonephritis, two patients of functional gastrointestinal disease, two patients of pelvic inflammatory disease, one patient of ovarian teratoma torsion, ovarian cyst, intussusception, cystitis, constipation, Henoch-Schlein purpura, diverticulitis each. Pathways of visit in hospital was most prevalent in emergency department all of group A, group B and group C and admission in hospital was most prevalent in department of surgery both group A and group C.
Conclusions: AP and ML were frequent in children with acute abdominal pain. The white blood cell count, ESR and CRP values were more higher in AP than ML. Right lower abdominal tenderness and rebound tenderness were more frequent in AP than ML. Abdominal sonography was useful in differential diagnosis between AP and ML and other associated diseases. In children who visited to the hospital for acute abdominal pain, if patients have either right lower quadrant tenderness or rebound tenderness by physical examinations, then check for white blood cell count, ESR and CRP. High level of white blood cell count, ESR and CRP may means possibility of severe acute surgical abdomen or other associated diseases. Further differential diagnosis work-up should be taken such as abdominal sonography because of it's very fast, safe, cost-effective, non-invasive and high accuracy detecting for AP and ML, and detecting for other associated diseases such as ovarian cyst, ovarian torsion, pelvic inflammatory diseases and so on. In mesenteric lymphadenitis confirmed by abodominal sonography, If patients have sustained abdmonial pain, try to find out possibility of other associated diseases.