Svensk Kirurgi 3-18

138 SVENSK KIRURGI • VOLYM 76 • NR 3 • 2018 upphängning”. Detta ökar risken för torsion och kan föreligga bilateralt 29 . Symtomen är oftast akut insättande skrotal smärta men ibland kan endast låg buksmärta, illamående och kräk- ning förekomma och det är mycket viktigt att testiklarna alltid undersöks vid buksmärta hos pojkar 30 . I status finner man vanligen en ömmande, svullen, uppdragen, tvärställd testikel utan kremasterreflex. Operation bör ske skyndsamt inom fyra–sex timmar från smärt- debut. Om testikeln är viabel efter detorkvering skall pexi med tre icke resorberbara suturer mot skrotalväg- gen utföras. Även den kontralaterala testikeln skall fixeras 29 . De vanligaste differentialdiagno- serna till testistorsion hos barn är tor- sion av morgagnis hydatid och epi- didymit 31 . Undersökning, anamnes, ultraljud, urinsticka och infektions- prover kan vara till hjälp vid diag- nossättning men får aldrig fördröja exploration om testistorsion inte kan uteslutas. Sammanfattningsvis Kunskap om barnens olika kirur- giska sjukdomstillstånd bidrar till större trygghet, inte enbart för den behandlande doktorn, utan även för barnet och dess vårdnadshavare. Det är därför av yttersta vikt att man som akutläkare eller kirurg är väl förtro- gen med vad som kan dyka upp i nattens mörker. Glöm inte att barn- kirurger alltid finns bara ett telefon- samtal bort…  Referenser 1. SPOR. Available from: http://www.spor.se/. 2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990 Nov;132(5):910-25. PubMed PMID: 2239906. 3. Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995- 2009. World journal of surgery. 2012 Dec;36(12):2787-94. PubMed PMID: 22948195. 4. Almström. M SJF, Svenningsson. A, Hagel. E, Wester. T. Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013. BJS Open. 2018. 5. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? Jama. 2007 Jul 25;298(4):438-51. PubMed PMID: 17652298. Pubmed Central PMCID: 2703737. 6. Minneci PC, Deans KJ. Management of Acute Appendicitis, Comparative Effec- tiveness Research, and the Nuances of Study Design-Reply. JAMA surgery. 2016 Aug 1;151(8):784-5. PubMed PMID: 27074112. 7. Svensson JF, Patkova B, Almstrom M, Naji H, Hall NJ, Eaton S, et al. Nono- perative treatment with antibiotics versus surgery for acute nonperforated appen- dicitis in children: a pilot randomized controlled trial. Annals of surgery. 2015 Jan;261(1):67-71. PubMed PMID: 25072441. 8. Andersson RE, Petzold MG. Nonsur- gical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Annals of surgery. 2007 Nov;246(5):741-8. PubMed PMID: 17968164. 9. Nadler EP, Reblock KK, Vaughan KG, Meza MP, Ford HR, Gaines BA. Pre- dictors of outcome for children with perforated appendicitis initially treated with non-operative management. Surgical infections. 2004 Winter;5(4):349-56. PubMed PMID: 15744126. 10. Aziz O, Athanasiou T, Tekkis PP, Purkay- astha S, Haddow J, Malinovski V, et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Annals of surgery. 2006 Jan;243(1):17-27. PubMed PMID: 16371732. Pubmed Central PMCID: 1449958. 11. Markar SR, Blackburn S, Cobb R, Kart- hikesalingam A, Evans J, Kinross J, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. Journal of gast- rointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2012 Oct;16(10):1993-2004. PubMed PMID: 22810297. 12. Saito JM. Beyond appendicitis: evalua- tion and surgical treatment of pediatric acute abdominal pain. Current opinion in pediatrics. 2012 Jun;24(3):357-64. 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