Clinical Cases

Appendicitis in a Child of Six

Appendicitis Complicated with Abscess In a 9 Year Old Boy with Achondroplasia

Dr. Surabhi Chitre discusses appendicitis and presents a case in a child of 6 years, who had complained of agonizing pain in the abdomen, nausea, vomiting and fever. Colocoynthis and Phosphorus helped relieve symptoms and prevent surgery.

Keywords:

Acute Appendicitis, non-obstructive, Murphy’s triad, Alvarado’s score, Homoeopathy, Colocynthis, Phosphorus.

Introduction:

One of the commonest conditions of the acute abdomen requiring an emergency surgical intervention is appendicitis. It is the most frequent condition to require a surgery worldwide. [1]Typical clinical findings of the condition, history of pain and examination usually should create a suspicion towards the diagnosis of acute appendicitis. The exact causes of the condition are yet not known but we candefinitely say it’s not of a single origin and many factors such as hereditary, dietary habits, obstruction of the lumens etc. should be thought of.The conventional treatment is a laparoscopic appendectomy.[2] The condition requires serious attention and can be fatal if is not treated on priority, as the appendix may burst and the infection can lead to serious complications.[3]The incidence of acute appendicitis is seen more in spring and summer which is rising sharply, and low in winter and fall according to some studies. [4] It is also known as epidemic appendicitis, as it is commonly found in the months of May to August.[5]

USG and CT scan can be used to confirm the diagnosis; blood and urine tests can also be done. [8]

Alvarado’s Score

The Alvarado’s score can be used to diagnose and understand the probable stage of appendicitis (mild, moderate, severe). Ultrasound and computed tomography (CT) scanning, are procedures which require a high cost. This tool can be particularly useful in low resource countries where imaging techniques cannot be used for unavoidable reasons.[6]

Alvarado score
Symptoms
Abdominal pain that migrates to the right iliac fossa1
Anorexia (loss of appetite) or ketones in the urine1
Nausea or vomiting1
Tenderness in the right iliac fossa2
Signs
Rebound tenderness (Blumberg)1
Fever of 37.3 °C or more1
Laboratory
Leukocytosis > 10,0002
Neutrophilia > 70%1
TOTAL10

A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis. [7]

 Case Presentation

Presenting complaint and follow up

A 6 year oldfemale child came to us with severe pain in the abdomen and fever since one day.The pain was more on the right side and was not constant but appeared and disappeared in paroxysm. The pain started around the umbilical area and radiated towards the right lower abdomen and settled there. The child could not move in bed due to the pain. The child was also complaining of nausea and one episode of vomiting, she was warm to touch on examination. The temperature was 101F. (Murphy’s triad) [5] There was pain and tenderness which was marked and the child refused to let anyone touch her abdomen. The child was irritable due to pain. Based on this presentation the remedy Colocynthis 200 was prescribed, 4 pills diluted in half cup of water and administered every 30 minutes till the pain subsided. There was not much improvement seen after 2 hours and the potency was changed from 200 to 1M, again diluted and given every 30 minutes. After 2 doses of Colocynthis 1M the pain started reducing in intensity and the interval between the pain paroxysms started increasing. After administration of 8 doses the pain disappeared and the child was able to change position.

Colocynthis was followed by the remedy Phosphorus 30 TDS for a month to avoid the re-occurrence of appendicitis. The patient followed up for 3 months and was on Phosphorus 30. There was no re-occurrence of any symptoms and the patient is still under observation on sac lac.

P/H and F/H: No significant past and family history.

Physical generals:

Appearance: Fair, lean and thin child.

Desires: Chocolates. Rice, Ice cream

Aversion: Vegetables

Thermals: Chilly patient

Sleep: Position of sleep on sides

Report:

 Repertorial analysis: [9]

 Comparative M.M. Discussion: Though the remedy Colocynthis was 5th in the repertorisation chart yet it was selected, as Belladonna didn’t cover the symptom of irritability with pain which is a general symptom that was important here in the totality.The anxiety and restlessness of Arsenic was not present. Chamomilla is more irritable in comparison to Colocynthis.This child was irritable when someone approached her; if someone talked to her, she was only crying and not ready to talk.Also,Chamomilla is very impatient and angry during pain but that was not present in this case. Colchicum covered more symptoms than Colocynthis butColocynthis has more intense paroxysmal pain which was marked in this child.The references are from Dr. Kent and Dr. Tyler, whereas paroxysmal pain in Colchicum was observed by Dr Allen in the proving and only one mark is given.

Phosphorus covered the totality and hence was prescribed after the acute attack subsided to avoid re-occurrence of such acute episodes. Phosphorus covers the physical generals of the child as well as the particulars.The Materia Medicasshow that it has a very good action on the appendix.[9] Hence the remedy Phosphorus was selected.

Conclusion: Homeopathy was effective in this case of acute appendicitis and helped avoid the complications and re-occurrences of the condition.Here it worked in a child and surgical intervention was avoided.

References:

  • Acute appendicitis in adults: Clinical manifestations and differential diagnosis Ronald F Martin, MD

https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis

4)    Incidence of acute appendicitis – observed seasonal differences NARINDER TANEJA Med J Armed Forces India PMCID: PMC5530780 PMID: 28769419

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530780/

  • Manual of surgery sriram bhat m 5th edition page no 938,  940

6)    The Alvarado score for predicting acute appendicitis: a systematic review Robert Ohle et al BMC Med PMCID: PMC3299622 PMID: 22204638

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299622/

7)    https://en.wikipedia.org/wiki/Alvarado_score#cite_note-6

8)    https://www.stlouischildrens.org/conditions-treatments/appendicitis

Radar 10.0 Schroyens F., Synthesis 9.0 (English

  • Bedside clinical tips farokh j master.

About the author

Surabhi Chitre

Surabhi Chitre

Dr. Surabhi Chitre B.H.M.S graduated from Dhondumama Sathe Homoeopathic Medical College and completed a one year internship from Chandaben Homoeopathic Medical college. She has been working with Dr. Farokh Master for the last two years in his private clinic and in his Sion Charitable clinic, two days a week. for the last 1.5 years

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