stiinte med 1 2012.indd - Academia de Ştiinţe a Moldovei

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Because of the diversity of types and forms of
acute generalized appendicitis, and the particularities
depending of the type of appendicitis, an individual
adapted treatment should be considered [6, 10, 13].
Materials and methods
A total number of 320 patients admitted and
treated for in The National Scientific-Practical
Center of Pediatric Surgery “Academician Natalia
Gheorghiu” in the period of 5 years (2006-2011) for
acute appendicular generalized peritonitis have been
examined.
The age of the patients was of 6 months – 18
years. There were determined during preoperative
period clinical features, laboratory data such
hemoleucograma, urinary sediment, liver enzymes,
data of hidro-electrolitical, metabolic and acidbasic
disturbances, creatinine, urea, glicemia, testes
of coagulation, abdominal echografy, abdominal
radiography.
Results
The clinical features were different depending
of the age of the patient, the surface of affected
peritoneum, the type of causal agent, the time from
the onset of the disease, the associated pathologies.
The main clinical symptoms were determined
by reflex signs (abdominal pain, tenderness, specific
position of the patient) and toxically signs (fever,
abdominal distension, intestinal paresis, general
endotoxicosis).
Differential diagnosis have been made with
pleuropneumonia, intestinal obstruction, internal
bleeding, enterocolitis, intussusception, acute
diverticulitis, infectious of digestive system, torsion
of annexes, gastric perforation).
It was established that 46 % of the patients were
admitted in very severe state, in severe state were
admitted 35 % of the patients and 19 % in moderate
severe state. From all the patients, in 58 % of the
cases, associated diseases were present.
In laboratorial findings, anemia was revealed in
18 % of patients, leucopenia- in 8 % and disturbances
of basis and acid balance – in 92 % of the cases.
We determined ceruloplasmine in patients’ serum
to appreciate the severity of disease and to monitor
evolution and prognosis during the treatment. It was
decreased at all 6 clinical periods (admitting, during
surgical intervention, the first day after surgery, the
5-th day after surgery, the 10 day and at delivery from
hospital) in comparison with control group. Also, a
level of reactive C protein had been appreciated, which
was increased from admition in the clinic and during
all clinical steps, in specially in patients of 3-10 years
old (p