Appendicitis

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What is appendicitis?

Appendicitis is inflammation and infection of the appendix, a small tube-shaped organ attached to the large intestine. The appendix is located in the right lower abdomen. Appendicitis results from blockage in the appendix caused by dried mucus, hard stool, parasites or other foreign bodies. When a blockage occurs when it can no longer drain into the large intestine and as the appendix swells, the patient may complain of abdominal pain, loss of appetite and nausea. As the swelling continues the blood supply to the appendix is impaired causing inflammation, infection and ultimately perforation (rupture). If untreated, the infection can then spread and lead to peritonitis, a life threatening infection of the abdomen.

What are the symptoms of appendicitis?

There is a wide range of symptoms, and not all children have all symptoms. The most common symptoms include:

  • Pain that usually begins in the center of belly, around the belly-button, and then moves downward and to the right, near the area the appendix. This usually becomes worse as time passes, when moving, taking deep breaths, coughing, sneezing and being touched in the area. The location of the pain is often hard for preschool children to describe.
  • Lack of hunger
  • Nausea and vomiting
  • Fever and chills
  • Diarrhea or constipation
  • Urinary symptoms such as urinating frequently and pain with urination

How is appendicitis diagnosed?

Medical history, physical examination, laboratory studies, and imaging studies as indicated are utilized to make the diagnosis. Your child may undergo:

  • Blood tests -These are used to evaluate the infection or to determine if there are any problems with other abdominal organs such as the liver or pancreas.
  • Urinalysis – This is done to diagnosis a bladder or kidney infection, both of which have symptoms similar to appendicitis.
  • Abdominal ultrasound – This procedure uses sound waves to take pictures of the inside of the body.
  • Computerized tomography (CT) – This procedure uses X-rays to take pictures of many different parts of the body.The machine takes pictures of very small sections of the body part being scanned.

How is appendicitis treated?

Non-perforated appendicitis

Treatment for appendicitis is removal of the appendix (appendectomy). Patients receive antibiotics both before and after surgery. In nearly all cases, laparoscopic surgery rather than open surgery is performed. This technique involves making a few small incisions in the belly and inserting a very small camera and surgical instruments. The pediatric surgeon then removes the appendix with the instruments. If the appendix has not perforated, most children are able to go home from the hospital within 24-48 hours and are able to return to school in one week.

Perforated appendicitis

If your child’s appendix is perforated, an appendectomy may performed either laparoscopically or by an open operation. Either approach is acceptable and often the determination is made by the surgeon as to what he or she believes is best for your child. The child is then treated with an extended course of antibiotics, which may be completed at home if the child is doing well otherwise.

Perforated appendicitis with abscess

At times, when the appendix has perforated and the infection has localized to one area, an abscess forms. Your surgeon will make the determination to proceed with immediate appendectomy or drainage of the infection (abscess), intravenous (IV) antibiotics, and delayed appendectomy. Percutaneous (through the skin) drainage is done using radiologic imaging to help guide a small tube through the skin into the infected area. An appendectomy is then performed approximately 6-8 weeks after the infection has been treated.

How long will my child be in hospital?

A child with non-perforated appendicitis is generally in the hospital for 1-2 days following surgery.

A child with perforated appendicitis may require hospitalization for up to one week or longer. The child must stay in the hospital until they are:

  • Eating
  • No longer having high fevers for at least 24 hours
  • Able to walk in the hallway
  • Pain is managed with oral pain medications
  • In selected cases, lab tests are used to guide the length of treatment

What is the long-term outlook?

Children can live a normal life without an appendix, with no changes in diet, exercise, or lifestyle.

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