Pediatric Infection and Vaccine

  • 제25권1호
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  • Pages.1-7
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  • 2018
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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소아 청소년의 급성 충수염: 천공과 연관된 인자 및 원인균

Acute Appendicitis in Children and Adolescents: Factors Associated with Perforation and the Causative Organism

  • 이솔 (한림대학교 의과대학 한림대학교 성심병원 소아청소년과) ;
  • 권혁진 (한림대학교 의과대학 한림대학교 성심병원 소아청소년과) ;
  • 안수민 (한림대학교 의과대학 한림대학교 성심병원 소아외과) ;
  • 이관섭 (한림대학교 의과대학 한림대학교 성심병원 영상의학과) ;
  • 김광남 (한림대학교 의과대학 한림대학교 성심병원 소아청소년과)
  • Lee, Sol (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kwon, Hyuck Jin (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Ahn, Soo Min (Department of Pediatric Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Kwan Seop (Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Kwang Nam (Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
  • 투고 : 2017.08.04
  • 심사 : 2017.10.26
  • 발행 : 2018.04.25
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초록

목적: 본 연구에서는 천공성 충수염을 예측할 수 있는 인자들을 분석하고, 원인균을 조사하고자 하였다. 방법: 2012년 1월부터 2014년 12월까지 한림대학교 성심병원에서 19세 미만에 충수염으로 수술을 진행한 569명을 대상으로 하였다. 이들의 입원 당시의 병력청취 기록과 혈액검사, 영상검사, 균 배양검사를 분석하였다. 결과: 총 569명 중 127명(22%)에서 천공이 확인되었다. 충수염의 천공 비율은 소아기, 학령기, 청소년기에서 각각 50%, 27.8%, 16.8%였다. 높은 C-반응단백질 수치, 충수대변돌 존재가 천공 충수염의 위험인자였다(P<0.001). 24명의 환자에서, 수술 중 복강 내 복막액 또는 충수 주위에 농이 관찰될 때 균 배양검사를 시행하였고, 16명(66%)에서 균이 배양되었다. 가장 많이 배양된 균은 Escherichia coli(n=10)였다. 나머지 균은 Pseudomonas aeruginosa, Streptococcus spp., Staphylococcus spp.였다. 결론: 5세 이하의 환자에서 충수염의 천공 비율은 50%였고, 천공 비율은 나이가 많을수록 낮았다. 충수염 진단 당시 C-반응단백질 수치가 높거나, 영상검사에서 충수대변돌이 관찰될 때, 천공성 충수염 가능성이 높으므로 주의해야 한다.

Purpose: This study aimed to determine which factors are related to perforated appendicitis. We also conducted a survey to identify the causative organism. Methods: From January 2011 to December 2014, 569 pediatric patients (322 male) younger than 19 years old who underwent an appendectomy due to acute appendicitis at Hallym University Sacred Heart Hospital were enrolled. Patients' medical records were reviewed retrospectively to determine their clinical manifestations, laboratory and imaging results, and pathogens. Results: About 127 patients (22%) had perforated appendicitis. The rate of perforated appendicitis in preschool, late childhood, and adolescent ages were 50%, 27%, and 16.8%, respectively. The risk factors of perforation were high C-reactive protein levels and the presence of appendiceal fecalith (P<0.001). Of the 24 samples of peritoneal fluid and periappendiceal pus that were collected intraoperatively, 16 were culture positive. The most common pathogen was Escherichia coli (n=10), and others were Pseudomonas aeruginosa, Streptococcus spp., and Staphylococcus spp. Conclusions: The perforation rate of appendicitis among patients younger than 5 years old was 50%, and this decreased in proportion with age. Clinicians should be aware of the possibility of perforation when patients with appendicitis have high C-reactive protein levels or the presence of appendiceal fecalith on imaging.

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참고문헌

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