Çocukta akut apandisit

Özet

Akut apandisit çocuklarda, özellikle küçük çocukta klinik bulguları silik olabilen ve hızla komplike hale gelebilen cerrahi karın nedenidir. Ultrason ilk basamak olsa da sonuç belirsiz kaldığında veya alternatif tanı araştırıldığında, intravenöz kontrastlı BT apendiksi ve çevresini birlikte gösterir. BT'de yalnız geniş çap değil, duvar hiperemisi, lümen içeriği ve çevre yağdaki reaksiyon bir arada okunmalıdır. Tanının gecikmesi perforasyon, apse ve yaygın peritoneal inflamasyonla sonuçlanabilir.

Faz ve pencere

Portal tanısal

İntravenöz kontrast sonrası kör sonlanan apendiksin lümen sıvısı, duvar kalınlaşması ve duvar kontrastlanması; çevresindeki yağ çizgilenmesi, çekum ucu reaksiyonu ve lokal sıvı aynı incelemede değerlendirilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Apendiks genişlemesi — çekumdan çıkan kör sonlanan tüp sıvıyla dolu ve gergin görünür; çap tek başına tanı koydurmaz.
• Duvar hiperemisi — kontrastlanan apendiks duvarı komşu bağırsak duvarına göre belirginleşir; ileri inflamasyonda duvar kalın da izlenebilir.
• Periappendiküler yağ çizgilenmesi — apendiks çevresindeki mezenterik yağın homojen düşük yoğunluğu yerini bulanık, çizgili görünüme bırakır.
• Appendikolit — lümen içinde yüksek yoğunluklu, bazen çevresinde ince yumuşak doku halkası bulunan odak; tıkanan lümenle ilişkisi aranır.
• Çekum ucu reaksiyonu — apendiks tabanı komşuluğunda fokal duvar kalınlaşması veya kontrastlanma artışı görülebilir.
• Lokal inflamatuvar sıvı — sağ alt kadran ya da pelviste az miktarda sıvı olabilir; tek başına apandisit kanıtı sayılmaz.

Normalde

Normal çocuk BT'sinde apendiks çekumdan çıkan, ucu kapalı, ince duvarlı ve çevresinde çizgilenme bulunmayan bir tüp olarak izlenebilir; hava içermesi normal olasılığını destekler. Apendiksin çapını tek başına karar ölçütü yapmadan duvarın görünümünü, lümen içeriğini ve çevre yağın keskinliğini aynı düzeyde karşılaştır.

Ayırıcı tanı

Sağ alt kadran ağrının gastrointestinal kökenli ayırıcı tanılarından biridir.

Terminal ileit

inflamasyon terminal ileum segmenti boyunca uzanır; apendiks normal olabilir.

İnvajinasyon, apandisit şüphesinde BT ile değerlendirilebilen sağ alt kadran ağrısı ayırıcı tanılarındandır.

Akut apandisite benzerlik gösteren ayırıcı tanıdır; kontrastlı BT ile uyumlu bulgular verebilir.

Klinik olarak akut apandisite benzerlik gösterir; görüntüleme bulguları belirsizdir veya kör sonlanan ileal yapı olarak izlenebilir.

Tuzaklar

• Çapı geniş ama havası olan, duvarı ince ve çevre yağı temiz apendiksi tek başına apandisit kabul etme; çocuklarda normal çap aralığı geniş olabilir.
• Az miktarda basit pelvik sıvıyı perforasyon göstergesi sayma; karmaşık koleksiyon, duvar defekti veya dışarı taşmış appendikolit gibi eşlikçiler ara.
• Çocukta az intraabdominal yağ bulunduğunda çizgilenmenin silik kalabileceğini hesaba kat; duvar kontrastlanması ve apendiksin biçimini de izle.

Kendini dene

1. Sağ alt kadranda sıvı dolu kör sonlanan apendiks, duvar hiperemisi ve çevresel yağ çizgilenmesi var. En olası tanı nedir?

   • Akut apandisit
   • Mezenterik adenit
   • Terminal ileit
   • Omental infarkt
   Cevabı göster

   Akut apandisit. Kör sonlanan sıvı dolu apendiks, duvar kalınlaşması/enhancement ve periappendiküler yağ çizgilenmesi akut apandisitin tipik görüntüleme bulgularıdır. Bu üçlü birlikte varken diğer ayırıcı tanı olasılıkları düşüktür.

2. Geniş görünen apendiks hava içeriyor; ince duvarlı ve çevre yağı temiz. Bu görünüm en çok neyi düşündürür?

   • Normal apendiks
   • Perfore apandisit
   • Meckel divertiküliti
   • İnvajinasyon
   Cevabı göster

   Normal apendiks. İntralümenyal hava, pürüzsüz/ince duvar ve temiz periappendiküler yağ, inflamasyonu desteklemez. Çap tek başına tanı koydurmaz; enfeksiyon bulgusu yoksa normal varyant olarak değerlendirilir.

Bu konunun yer aldığı turlar

• Çocukta acil BT

İlgili konular

• İnvajinasyon: ileokolik

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.