虫垂炎との戦いが終わった
War is over against appendicitis
柔道好きの小学生の子供が虫垂炎入院から退院した。Elementary school Judo kid came back from hospitalization due to appendicitis.
７日前、３８度の熱と頭痛で医者に行くも、インフルエンザ検査は陰性。２日程自宅静養。7 days ago, went down to doctor because of 38 centigrade fever and head aches but was diagnosed as influenza negative.
３日目の朝、平熱に戻り登校。ところが、一時間目に３８度の発熱と腹痛で保健室から連絡。近所の医院で診察。白血球が平常レベルであることから医師は炎症なしと判断、代わりに腸内ガスを疑い浣腸処置。しかし腹痛は激痛に変わり、医師は総合病院へ救急搬送指示。3rd day morning, went up to school since temperature has gone down to normal. However during the 1st class of the day, got a call from school infirmary, reporting 38 centigrade fever as well as stomach ache. Near-by doctor prescribed enema due to normal level of white blood cell count however, stomach ache soon turned into severe pain, then doctor directed urgent transfer to general hospital.
エコー、Ｘ線、造影剤ＣＴで、虫垂炎と診断。It was diagnosed as appendicitis after echographic exam, X-ray as well as contrast enhanced CT.
初期段階のため、手術でなく抗生剤療法が選択可能で、直ちに入院。初日夜４０度の発熱はあったが、回診の度に右下腹部の触診による痛みは徐々に減少し、５日で消滅。６日目に退院。Due to very early stage in development, we could choose antibiotics treatment instead of surgery then was hospitalized immediately. Peaked by first night fever of 40 centigrade, the pain at right lower bottom abdomen gradually faded every time doctor came on periodical examination tour and the pain disappeared by day 5. We left hospital in day 6.
以下感じたこと。Below, what I felt.
療法選択：抗生剤療法で手術を避けても３０％程度＝通常の４倍の確率で虫垂炎を再発する。今回、抗生剤を選んだのは、開腹はできるだけ避けるべきだと思ったことと、できるだけ手術痕を子供に残したくなかったから。でも、最近の手術は昔と比べ進歩しているようで、再発リスクを考えると判断が正しかったかどうか自問中。子供の虫垂炎は大人より急速に悪化するため、後日に計画的に手術をする人も多いそうだ（医師の診断の上、保険適用可）。
The choice of treatment: Even if you avoid surgery by way of antibiotics treatment, in the probability of 30%, that is 4 times high as normal, recurrence is observed. We chose antibiotics treatment to avoid operation as well as surgery scar. However recent operation looks advanced than before, hence considering the risk of recurrence, I am asking myself if my decision was right. Since kid's appendicitis get worse much faster than adults, many people plans surgery later(insurance covered when doctor agrees).
診断精度：炎症の指標である白血球増加は激痛発生とはタイムラグがあり、結果的に初期の虫垂炎の診断には使えなかった。一方、造影剤ＣＴ、エコーも常備できる価格ではない。初期診断精度を上げるには、検査機器のさらなる低価格化が必要だ。
The precision of diagnostics: There is time lag between white blood cell count as the inflammation indicator, and the start of severe pain, hence it cannot be used for diagnostics of appendicitis in very early stage. Meanwhile, echographic exam as well as contrast enhanced CT are too expensive for local clinic. Cost reduction of those medical equipments is necessary to increase precision of initial diagnostics.
コスト面：乳幼児医療証により支払いはほぼゼロ。手術を行っていないので、実際のコストは推定２５万円程度だと思う。健康保険料は高いが必要だと実感。
For cost: Thanks to additional insurance provided for infant, there was no payment. Approximate cost incurred will be around JPY250K since we had no operation. Really felt that insurance is necessary although monthly fee is expensive.
自分の心：まだこどもが赤ちゃんの頃、何度も熱をだしたり救急車を呼んだりしたことを思い出した。普段は当たり前で気にもしない、しかし何物にも代えがたい健康の大切さ。自分も家族も手術の体験が全くなく、デフォルトで手術が選択されることに慌てた。
My emotion: I recalled time when kids were baby and had fever or time when I called ambulance. Such an indispensable thing, health, that we take it for granted normally. I was also surprised that surgery is set as default treatment since neither me nor family had ever went through operation at all.
もし、運悪く子供が虫垂炎になったら参考にしてください。 Just for those who have kid happen to have appendicitis unfortunately.
[ 2022/1/5 Added ]
その後、２年後に再発。抗生物質で入院対応。そのまた1か月後に再発。３度目の抗生物質対応。そして、遂に「待機的手術」を決心。一か月後に手術を行い、虫垂は切除された。Two years later, it came again. Hospitalized and took anti-biotics. Then one month after that, it came back once more. Anti-biotics treatment for the 3rd time. After all, we decided surgical solution on elective basis. Surgical operation was done one month later. Appendices was removed.
手術は内視鏡（多分Senhance）。多臓器への癒着はなかった。事故無く、きれいに仕上げてくれた担当医師には感謝。手術痕は最小限。待機的手術は「緊急手術」より遥かにお薦め。どう考えても、夜中に起こされて大至急行う手術より、計画的に準備して行う手術の方が安全で、仕上がりも良いだろうから。Surgery operation was done by endoscope( probably Senhance). No adhesions to other organs were found. Thankful to doctor who completed the operation safe and beautiful. Surgical scars were minimal. Elective surgery is very much recommended than emergency surgery. However you think, planned and well prepared surgical operation should be safer and better than the operation done at night by doctor who was waken up in the middle of night.
現在、内視鏡手術は手術で開ける穴が臍の一か所である単孔式がある。でも、技術的に難易度が高いようで普及しておらず、臍に加えて２か所孔をあけるタイプだった。手術痕は小さく、大人になった時点で言われないと気付かないレベルにまで消えそうな感じになると思われる。Currently there is single port VATS(video-assisted thoracic surgery) that opens up only one port in belly button. However, it looks technically difficult and is not common. Hence 3 port VATS was taken this time. Surgical scars looked small enough to be negligible when my kid grows up to adult unless explicitly explained what happened before.