Appendicitis

What is appendicitis?

Appendicitis is an irritation, inflammation and infection of the appendix (a narrow, hollow tube that branches off the large intestine). The appendix functions as a part of the immune system during the first few years of life. After this time period, the appendix stops functioning and other organs continue helping fight infection. Appendicitis is the most common cause of emergency surgery in childhood.

What causes appendicitis?

Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, stool or parasites. The appendix then becomes irritated and inflamed. The blood supply to the appendix is cut off as the swelling and irritation increase. Adequate blood flow is necessary for a body part to remain healthy. When the blood flow is reduced, the appendix starts to die. Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus and other substances to leak through and get inside the abdomen. An infection inside the abdomen known as peritonitis occurs when the appendix perforates.

How often does appendicitis occur?

Most cases of appendicitis occur between the ages of 6 and 20 years. It is uncommon in children under 4 years, but the rate of perforation is high in this group since young children are unable to tell exactly how they feel and "where it hurts."

Appendicitis occurs in equal numbers in boys and girls.

About four appendectomies (surgical removal of the appendix) are done in every 1000 children under the age of 14.

Why is appendicitis a concern?

An irritated appendix can rapidly turn into an infected and ruptured appendix, sometimes within hours. A ruptured appendix can be life threatening. When the appendix ruptures, bacteria infect the organs inside the abdominal cavity, causing peritonitis. The bacterial infection can spread very quickly and be difficult to treat if diagnosis is delayed.

What are the symptoms of appendicitis?

The following are the most common symptoms of appendicitis. However, each child may experience symptoms differently. Symptoms may include:

  • Pain in the abdomen which:
    • May start in the area around the belly button and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen.
    • Usually increases in severity as time passes.
    • May be worse with moving, taking deep breaths, being touched and coughing or sneezing.
    • May spread throughout the abdomen if the appendix ruptures.
  • Nausea and vomiting.
  • Loss of appetite.
  • Fever and chills.
  • Changes in behavior.
  • Diarrhea or constipation.

When should your child's physician be called?

Since an infected appendix can rupture and be a life-threatening problem, please call your physician immediately if you think your child has appendicitis.

How is appendicitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include:

  • Abdominal ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • Computed tomography scan of the abdomen, with or without barium - (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.
  • Barium enema - a procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages) and other problems.

Other tests may include:

  • Blood tests - to evaluate the infection, or to determine if there are any problems with other abdominal organs, such as the liver or pancreas.
  • Urinalysis - to detect a bladder or kidney infection, which may mimic the symptoms of appendicitis.

Symptoms of appendicitis may resemble other conditions or medical problems. Consult your physician for a diagnosis.

Treatment for appendicitis:

Specific treatment for appendicitis will be determined by your child's physician based on the following:

  • The extent of the problem.
  • Your child's age, overall health and medical history.
  • The opinion of the surgeon and other physicians involved in the child's care.
  • Your child's tolerance for specific medications, procedures or therapies.
  • Expectations for the course of the problem.
  • Your opinion and preference.

Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, physicians will recommend that the appendix be removed with an operation.

The appendix may be removed in two ways:

  • Open method - Under anesthesia, an incision is made in the lower right-hand side of the abdomen. The surgeon finds the appendix and removes it. If the appendix has ruptured, a small drainage tube may be placed to allow pus and other fluids that are in the abdomen to drain out. The tube will be removed in a few days, when the surgeon feels the abdominal infection has subsided.
  • Laparoscopic method - This procedure uses several small incisions and a camera called a laparoscope to look inside the abdomen during the operation. Under anesthesia, the instruments the surgeon uses to remove the appendix are placed through several small incisions and the laparoscope is placed through another incision. This method is not usually performed if the appendix has ruptured.
    After surgery, children are not allowed to eat or drink anything for a specified period of time so the intestine can heal. Fluids are given into the bloodstream through small plastic tubes called IV's until your child is allowed to begin drinking liquids. Your child will also receive antibiotics and medications to help your child feel comfortable through the IV. Eventually, children will be allowed to drink clear liquids (such as water, sports drinks like Gatorade or PowerAde, or apple juice) and then gradually advance to solid foods.

A child whose appendix ruptured will have to stay in the hospital longer than the child whose appendix was removed before it ruptured. Some children will need to take antibiotics by mouth for a period of time specified by the physician after they go home.

What happens after my child leaves the hospital?

Your physician will generally recommend that your child not do any heavy lifting, play contact sports or "rough-house" for several weeks after operation. If still in place when goes home, your child should not take a tub bath or go swimming until the drain is removed.

Your child may need to take antibiotics at home to help fight the infection in the abdomen.

You will be given a prescription for pain medication for your child to take at home to help your child to feel comfortable. Some pain medications can cause constipation in children, so ask your physician or pharmacist about any side effects the medication might have. Moving around after surgery rather than lying in bed can help prevent constipation. Drinking fruit juices and eating fruits, whole grain cereals and breads and vegetables after being advanced to solid foods can help with constipation as well.

Most children who have their appendix removed will have no long-term problems.