Appendicitis in Children
What is appendicitis?
Appendicitis occurs when the appendix, an appendage (extension) of the colon, becomes inflamed (swollen) and infected. In many cases, an obstruction (blockage) within the appendix causes the infection, resulting in bacterial overgrowth. In 20 to 30 percent of children, the appendix ruptures and releases the infection into the abdominal cavity.
How common is appendicitis?
Appendicitis affects 80,000 children per year in the United States. It is most common in the second decade of life. Fifty percent of children will have a family history of appendicitis. Appendicitis is the most common cause for emergency abdominal surgery in childhood.
Ruptured appendicitis occurs in 30 percent of patients and is more common in children under five years old.
Symptoms and Causes
What are the symptoms of appendicitis?
Because the appendix is located in the lower right portion of the abdomen, the most important symptom is low abdominal pain. This often starts around the belly button and moves to the lower right side later. Other symptoms include:
Diagnosis and Tests
How is appendicitis diagnosed?
The main signs of appendicitis are a history of pain in the right lower portion of the abdomen followed by vomiting and low-grade fever, and tenderness and rigidity (stiffness) in the same area.
Most patients will have imaging of their abdomen with ultrasound and/or a computed tomography (CT) scan. Blood tests and examination of the urine may also be performed.
No one test or finding is 100 percent accurate and reliable in diagnosing appendicitis. The physician must piece together all available information. In some cases, the only way to diagnose appendicitis is to perform surgery.
Management and Treatment
How is appendicitis treated?
The treatment is removal of the infected appendix with surgery. In some cases, when the appendix has already ruptured, surgery is done after a period of treatment with antibiotics.
During the surgery
- A pediatric anesthesiologist (a physician who specializes in pain relief and sedation in children) gives your child anesthesia, which brings on sleep.
- If a laparoscopic (minimally invasive camera technique) procedure is used, the surgeon will enter the abdomen with small instruments and a camera, inserted through several tiny incisions (cuts). Sometimes, a mildly larger incision is necessary to take out the appendix.
- The appendix is removed and the infected fluid is washed out of the abdominal cavity. In some cases, drains are placed to allow for the removal of infected fluid.
- The surgery generally takes less than an hour to complete.
After the surgery
The usual length of stay in the hospital is 12-24 hours for simple appendicitis, and 5 to 7 days for ruptured appendicitis. The child will receive intravenous (in the vein) pain medication and antibiotics during the hospital stay. Oral feedings are started slowly, usually starting with clear liquids. Your child will gradually advance to a regular diet. There may be a dressing over the incision.
Your child will be ready for discharge from the hospital when he or she can eat a regular diet, has no fever or drainage from the incision, and has normal bowel function.
What to expect after discharge from the hospital following appendix surgery
Most children will need a few days of rest at home before returning to school, and 2 to 4 weeks before returning to gym and sports, depending on how much inflammation there is.
When to call your child's health care provider
You may notice some minor swelling around the incision; this is normal. However, call your health care provider if your child develops any of the following:
- Excessive swelling, redness, or drainage from the incision
- Increasing pain
Follow-up office appointment
A follow-up outpatient visit will be scheduled one to two weeks after your child's surgery. Your child's health care provider will examine the wound and evaluate his or her recovery.