Appendicitis

Appendicitis is a sudden inflammation (swelling) of the appendix. The appendix is a small, finger-shaped tube that branches off of the large intestine, and appendicitis is one of the most common causes of emergency abdominal surgery in children. About four appendectomies per 1,000 children are done every year in the United States. Appendicitis is more common in males than females, and it’s most common in the late teens or early twenties. It’s rare, but can happen in children under two.

Appendicitis usually happens because the appendix becomes blocked by stool, some type of foreign body or, rarely, a tumor. The first symptom is usually crampy pain around the belly button. Usually, there is a reduced or absent appetite, and often nausea and vomiting occur. Sometimes there is a low-grade fever. The pain may get worse when the patient coughs. Then the pain may go away. As the appendix gets more and more inflamed, the pain becomes worse and moves down toward the right lower part of the stomach and finally becomes most severe right over the appendix. Sometimes, the appendix ruptures; when this happens, the child typically feels better for a while, then the pain becomes really severe and the stomach gets hard and sore.

It’s difficult to tell when a child gets appendicitis because children get nausea and vomiting more frequently than adults. Until the appendix is really inflamed, the child gets better and the parents are likely to think they had the flu. This is why perforation (or rupture) of the appendix is more common in children. Older children, teenagers and adults are easier to diagnose.

To diagnose appendicitis, the doctor presses on the child’s stomach and then releases it. If this results in more pain, it is a sign of appendicitis with perforation (already ruptured). Rectal examination also can cause increased pain on the patient’s right side. The doctor will have the technician draw some blood. With appendicitis, the white blood cell count is high. Other methods used to diagnose appendicitis are abdominal ultrasound – during this procedure, a soft probe is rubbed over the abdomen while pictures are taken of the intestines – and, sometimes, abdominal CTs. CTs are painless; your child just has to lie still on a table while X-rays are taken.

Once appendicitis is suspected or diagnosed, surgery is necessary. If the case appears uncomplicated (no rupture or infection), surgery will proceed right away. If the doctor suspects that there is infection or rupture, he or she may wish to start the patient on antibiotics before surgery to reduce the infection.

There are two ways to perform surgery. The operation may be an open procedure, in which an incision is made on the lower right side of the stomach. The incision goes left to right and is about two inches long. The alternative is laparoscopic surgery, in which three small puncture wounds are made in the abdomen so that a camera and scalpel can be inserted. These small puncture wounds are closed with one small stitch in each. Your surgeon will decide which way is best for your child’s condition.

It’s important to know that many times (about 10 to 15 percent of the time), once the surgeon looks at the appendix, it’s normal. This may seem like a lot of unnecessary surgery, but the risk of not operating on a child with appendicitis is very high and the child could die, so a rate of 10 to 15 percent of negative surgeries seems worthwhile. If the surgeon sees a normal appendix, he or she will probably remove it anyway while there and then explore the abdomen for other causes of the pain.

After surgery, your child will receive intravenous (IV) fluids until his or her bowels “wake up.” The nurses will place a stethoscope to your child’s stomach to listen for gurgling. Once the bowels start making noise and your child begins feeling gas pains, or passing gas, they will slowly start giving him or her some clear liquids and then food.

The pain is gone after surgery, and the child usually feels much better, even though there is an incision in the abdomen. Usually, for uncomplicated appendix operations, your child can go home the next day.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.