Acute appendicitis and peritonitis in children

The new edition of the clinical guidelines, developed by leading specialists of the Russian Association of Pediatric Surgeons (RADH), contains updated information on the treatment and diagnosis of the disease in accordance with the latest advances in emergency abdominal surgery. The recommendations are based on the results of completed domestic and international evidence-based studies, including systematic and randomized clinical trials. For diagnosis in a specialized surgical hospital, in addition to routine clinical and laboratory examination, the following are recommended as the main method of mandatory noninvasive instrumental diagnosis: ultrasound examination of the abdominal cavity; dynamic follow-up for doubtful diagnosis of acute appendicitis lasting up to 12 hours, followed by diagnostic laparoscopy. In the presented edition, the issues of classification of acute appendicitis and peritonitis in children are considered in detail. The main complicated forms are appendicular infiltrate, appendicular peritonitis (AP) and periappendicular abscess. It is not recommended to divide the appendicular infiltrate into forms. Conservative treatment with subsequent intervertebral appendectomy is recommended for appendicular infiltration. The division of appendicular peritonitis into forms is supported, depending on the prevalence of the inflammatory process in the abdominal cavity. The division of the periappendicular abscess into 3 stages is substantiated. The issues of surgical access, washing and drainage of the abdominal cavity are considered in detail, depending on the form of appendicular peritonitis and the stage of the periappendicular abscess. For the first time, material on the accumulated global experience in the conservative treatment of acute appendicitis in children is presented and the possibility of conducting such studies in large scientific centers after approval and approval by the RADH is considered. The issues of preoperative preparation, postoperative management and rehabilitation of patients with severe appendicular peritonitis are considered. The publication is intended for practicing pediatric surgeons, anesthesiologists, intensive care physicians, pediatricians and specialists in related specialties, as well as residents and graduate students of relevant fields.