Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy.Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected.Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time.Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.
Introdução: As Neoplasias de apêndice são raras e identificadas em cerca de 1% de todas as apendicectomias, sendo as etiologias mais comuns em primeiro de origem epitelial e em segundo, os neuroendócrinos. Os tumores neuroendócrinos são derivados das células enterocromafins, produzindo os grânulos Cromogranina A e Sinaptofisina e são o segundo tipo histológico mais comum de neoplasia em apêndice, muitas vezes, encontrados incidentalmente após apendicectomia devido sua apresentação indolente, mas, por vezes, são os causadores da apendicite aguda. Objetivo: Relatar a experiência sobre o caso de um paciente diagnosticado com tumor neuroendócrino de apêndice após apendicite aguda perfurada que havia apresentado, anteriormente, tromboses de vasos abdominais. Relato de caso: Paciente do sexo masculino, 28 anos, há 2 meses com dor abdominal em mesogástrio e epigástrio, sendo diagnosticado inicialmente com trombose intra-abdominal. Neste internamento, apresentou dor abdominal difusa mais proeminente em fossa ilíaca direita com descompressão dolorosa, submetido à videolaparoscopia exploradora e evidenciado apendicite grau 4. À análise histopatológica evidenciado tumor neuroendócrino em apêndice bem diferenciado G1 com tamanho de 2mm em maior eixo, índice mitótico com menos de 2 mitoses, estadiamento patológico pT1 pNx, margens livres, invasão linfovascular e perineural. Imuno-histoquímico com índice de proliferação celular (Ki-67) de 1% e identificação dos componentes Cromogranina A clone policlonal e Sinaptofisina clone DARKSYNAP positivo. Conclusão: Relatamos um caso de um paciente com Tumor Neuroendócrino de apêndice com apresentação inicial como apendicite aguda e, à patologia, limitada ao apêndice sem invasão linfovascular e teve a apendicectomia total como procedimento curativo.
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