Rare Emergency Appendectomy Doesn’t Keep 3-Year-Old Down For Long

Michael Rucci is an active 4-year-old who likes to play outside with his sisters and friends. He loves digging in dirt, playing soccer and wrestling. “My first two children are girls. His dad wanted a boy and he got it — Michael is all boy,” says Ashley Rucci, Michael’s mother. 

But something seemed off with the normally active boy on Sunday, August 20, 2023. Michael, who was 3 at the time, was lethargic and Ashley wondered what was wrong. Soon after, Michael started vomiting and had a low-grade fever.

Ashley, 37, an assistant nurse manager at Cleveland Clinic Hillcrest Hospital who lives in Mayfield Village, assumed Michael had a stomach bug and needed some rest and TLC. “Michael was complaining that his legs were sore and he was hunched over when he walked,” explains Ashley. “The day before, the kids and I worked on a community project cleaning up a stream. I thought maybe Michael picked up something there or caught a stomach bug.” 

By Tuesday, his symptoms worsened and Michael was feeling uncomfortable. Ashley made an appointment and took him to their pediatrician’s office. The caregiver said a virus was going around and suspected that’s what Michael had.

On Wednesday, at the urging of her husband and with Michael complaining that his back hurt, Ashley took Michael to Cleveland Clinic Children’s Pediatric Emergency Department at Hillcrest Hospital (Pediatric ED). 

During Michael’s evaluation, Ashley said his symptoms included: intermittent fever, abdominal pain, vomiting, diarrhea, pain with urination, dehydration, dark urine, back pain and walking hunched over.

Marina Molinari-Zuzek, MD, a pediatric emergency medicine specialist, came in to assess Michael. “When I first saw Michael, he clearly appeared ill, was hunched over and his belly was tender to the touch,” recalls Dr. Molinari-Zuzek. “Because a few things were out of the ordinary, I had a clinical suspicion about what may be causing Michael’s illness.”

Dr. Molinari-Zuzek ordered lab work and an ultrasound to verify her suspicion. The lab work ruled out certain issues but one of the tests came back elevated. The ultrasound showed what Dr. Molinari-Zuzek suspected — Michael had appendicitis. 

“Michael had appendicitis with appendicolith, which is a round, hard calcified deposit of fecal matter in the appendix that caused it to be inflamed,” explains Dr. Molinari-Zuzek. “The ultrasound technicians in our Pediatric ED are specially trained for pediatric patients, which is beneficial in cases like this.” 

Dr. Molinari-Zuzek immediately consulted with Anthony DeRoss, MD, a pediatric surgeon at Hillcrest Hospital. Because of the high level of pediatric care at the hospital, Michael would have an appendectomy at Hillcrest Hospital.

“As a nurse, I was shocked that Michael needed an appendectomy. That never crossed my mind,” says Ashley. “I learned that walking bent at the waist, or hunched over, is one of the tell-tale signs.”

Dr. DeRoss admitted Michael to the hospital and prescribed a regimen of antibiotics to contain the bacteria from the appendix. He also ordered medications to rehydrate him.

“The appendix is a small, tube-shaped structure attached to the first part of the large intestine. It isn’t terribly useful and probably causes more trouble than good,” says Dr. DeRoss. “It isn’t very common for a child Michael’s age to have appendicitis, with less than 5% of affected patients being under age 5 years.”  

In his hospital room, child life specialists came to talk to Michael about the surgery and provided toys and coloring books. “The child life specialists were a godsend. They kept Michael calm and gave me and his dad a little bit of a break. They were wonderful,” recalls Ashley.

The next morning, Dr. DeRoss performed a laparoscopic appendectomy, a less invasive surgery using microincisions that don’t leave much scarring. During the 53 minute surgery to remove the appendix, Dr. DeRoss made a lifesaving catch — Michael’s appendix was perforated and abscessed, meaning the appendix had ruptured, which could be life-threatening if not treated quickly. 

“There were some clues on the ultrasound, so I was expecting to encounter the abscess cavity,” recalls Dr. DeRoss. “Children under the age of 5 with appendicitis have an increased likelihood of a perforated appendix like Michael’s.”

After a short three-day recovery, Michael was discharged. “Michael was an excellent patient and his prognosis is positive; he shouldn’t have any issues from his appendectomy. His mother knew something wasn’t quite right and went with her intuition, which was key,” says Dr. DeRoss.

Michael began playing with his sisters almost immediately when he came home from the hospital. 

“Michael missed his first week of preschool because of surgery so it will always be a memorable start for us,” laughs Ashley. “Both Drs. Molinari-Zuzek and DeRoss listened to me and validated my concerns. I was happy I brought him to the Pediatric ED since the caregivers are specially trained to work with children. Everything happened very quickly, which turned out to be vital in this situation. I’m so thankful for the comprehensive care he received at Hillcrest Hospital and the Pediatric ED.”

Photos courtesy of Ashley Rucci.