Pediatric Surgery

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Appendicitis

Appendicitis (inflammation of the appendix) requires immediate medical attention, so it's important to learn its symptoms — and how they differ from a run-of-the-mill stomachache — so you can seek medical care right away.

The first symptoms of appendicitis usually are a mild fever and pain around the bellybutton. The pain usually worsens and moves to the lower right side of the belly. Vomiting, diarrhea or constipation, and loss of appetite are other common symptoms.

Call your doctor immediately if you suspect that your child has appendicitis. The earlier it's caught, the easier it will be to treat.

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About Appendicitis

The appendix is a small finger-like organ that's attached to the large intestine in the lower right side of the abdomen. The inside of the appendix forms a cul-de-sac that usually opens into the large intestine.

Blockage can be due to hard rock-like stool (called a fecolith), inflammation of lymph nodes in the intestines, or even parasites. Once the appendix is blocked, it becomes inflamed and bacteria can overgrow in it.

If the infected appendix isn't removed, it can burst and spread bacteria. The infection from a ruptured appendix is very serious — it can form an abscess (an infection of pus) or spread throughout the abdomen (this type of infection is called peritonitis).

Appendicitis mostly affects kids and teens between 11 and 20 years old, and is rare in infants. It's one of the most common reasons for emergency abdominal surgery in kids. Appendicitis is not contagious.

Symptoms

Call the doctor immediately if your child shows symptoms of appendicitis, including:

  • significant abdominal pain, especially around the bellybutton or in the lower right part of the abdomen (perhaps coming and going and then becoming consistent and sharp)digestive system animation
  • low-grade fever
  • loss of appetite
  • nausea and vomiting
  • diarrhea (especially small amounts, with mucus)
  • swollen or bloated abdomen, especially in infants

There is no way to prevent appendicitis, but with sophisticated diagnostic tests and antibiotics, most cases are identified and treated without complications.

If appendicitis goes untreated, the inflamed appendix can burst 24 to 72 hours after the symptoms begin. If the appendix has burst, the pain may spread across the whole abdomen, and the child's fever may be very high, reaching 104ºF (40ºC).

The symptoms of appendicitis can vary according to a child's age. In kids 2 years old or younger, the most common symptoms are vomiting and a bloated or swollen abdomen, accompanied by pain.

If you suspect that your child has appendicitis, call your doctor immediately and don't give your child any pain medication or anything to eat or drink unless instructed to by the doctor.

Diagnosis

Because the symptoms of appendicitis can be so similar to those of other medical conditions (like kidney stones, pneumonia, or even a urinary tract infection), it's often a challenge for doctors to diagnose it.

To confirm or rule out appendicitis, a doctor will examine the abdomen for signs of pain and tenderness, and order blood and urine tests. The doctor also might order other tests, like an X-ray of the abdomen and chest, ultrasound, or a CAT scan. If the doctor suspects appendicitis, you may be told to stop giving your child any food or liquids in order to prepare for surgery.

Treatment

Appendicitis is treated by removing the inflamed appendix through an appendectomy. Surgeons usually either make a traditional incision in the abdomen or use a small surgical device (a laparoscope) that creates a smaller opening. An appendectomy usually requires a 2- to 3-day hospital stay.

Before and after surgery, intravenous (IV) fluids and antibiotics will help prevent complications and decrease the risk for wound infections after surgery. If needed, your child will receive pain medication.

An infected appendix that bursts also will be removed surgically but might necessitate a longer hospital stay to allow antibiotics to kill any bacteria that have spread into the body.

Reviewed by: Yamini Durani, MD
Date reviewed: July 2012