Appendicular-genital syndrome in children

Abstract

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.