The early morning from Saturday to Sunday January 15, David Cruz took Norah, her 15 year old daughter to the emergencies of Terrassa Hospital because the youngest had woken up at midnight with “a lot of abdominal pain.” The doctors examined her and it seemed that everything was fine. “They told me that it could be that she was ovulating. But, as He had no fever or vomiting. They sent her home and prescribed painkillers,” says Cruz, who has sent a letter to the Entre todos section of EL PERIÓDICO to denounce her case.
However, just after leaving the hospital, at the door of the emergency room, the girl vomited. “We went back inside and they did a analytics. it came out a little anemia,” says the father. There was suspicion that she was a appendicitis (inflammation of the appendix), but the clinical picture of this ailment is, in its beginnings, very unspecific and diffuse.
Therefore, to find out if it is appendicitis, patients undergo a ultrasound, even though this test is not always conclusive. “The hospital told us that, to confirm or rule out appendicitis, I needed an ultrasound, but they didn’t have ultrasound machines [los técnicos que hacen ecografías] during the weekend. and that they could not disturb a surgeon because they could not confirm the diagnosis, since You couldn’t do that test.” says Cruz, a neighbor of Rubí.
With no other option, the family returned home. “They told us to come back on Monday if Norah was still unwell, that there would be ultrasound scans.” And so it was: on Monday, the girl already had fever and recurrent vomiting. He went to the hospital and ultrasound confirmed appendicitis. They operated on her urgently. “When we left the operating room they told us that his appendix had burst and it was peritonitis. Although in the final report that they gave us does not say ‘peritonitis’, but ‘acute gangrenous appendicitis with purulent exudation’, says Cruz.
Weeks later, the daughter having recovered, the father saw the case of the 12-year-old girl from Valencia who died of “purulent peritonitis” after having gone up to three times to the hospital, where no one diagnosed you nor did he perform any medical tests. That’s when Cruz decided to write to this newspaper and tell what happened to him. “I saw what happened in Valencia and I was scared. It reminded me of my daughter. We all know how an appendicitis that does not heal can end, “he explains. Although the minor is now fine, after the operation she was a week entered, given that “they had to open it”, because they could not perform a “laparoscopy” because of how bad it was.
Asked about this newspaper, the Terrassa Hospital assures that on weekends, and Depending on the patient’s pathology, the healthcare team indicates the guideline to follow in the same center or if necessary it is derived, as in the case of a complex ultrasound, when Parc Taulí Hospital in Sabadell”. However, Cruz assures that no one referred her daughter to Sabadell. The Terrassa Hospital avoids talking about the case of this patient for “privacy” issues.
action protocol
The pediatric surgeon Vall d’Hebron Hospital (Barcelona) Carles Gine warns that, since the case of the girl from Valencia occurred, people with abdominal pain who fear suffering from appendicitis do not stop arriving at the center’s emergencies, something that is often ruled out later. gine calls for calm
“Appendicitis has a Evolutionary process. At first the intestinal symptoms are very non-specific, but It’s getting more serious.” Giné account. It is often confused with gastroenteritis, but appendicitis has a whole action protocol.
When a child comes to the emergency room with suspicion of appendicitis, The first thing the pediatric team does is assess it. “Most pain is not appendicitis. When in doubt, surgeons are alerted. And, if there are still doubts, we make a ultrasound. If the ultrasound is conclusive, we operate. If not, we send the child home, but he must return the next day if he continues to feel unwell,” explains this surgeon.
Improved ultrasound
appendicitis usually “go to more” at seven or eight hours. In recent years, the sonograms They have improved a lot, but They do not always allow viewing of the appendix. “If the appendix is not fully visible, we do two things: in case the patient is clinically well, we leave it in observation and we reassess it after six or eight hours with another analysis. But, if you are symptomatic and there is reasonable doubt that it is appendicitis, we do a CT, which has one 100% sensitivity”, account.
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And why don’t they all get a CT? “Because the scanner generates significant ionizing radiation and in children it can cause radiation-induced cancer. That is why we try to reduce these tests a lot.” Giné assures that the majority of diagnostic delays are due to the patient he stays at home enduring the pain and they come back two or three days later with complicated situations.
Peritonitis is a serious condition that occurs when appendicitis is not treated in time. “If you let appendicitis evolve and it perforates, it causes an infection in the rest of the abdomen and is a potentially very serious condition”, concludes Gine.