Diseases & Conditions
Infection of the appendix, a small piece of tissue that connects to the beginning of the large intestine, usually at the lower right side of the abdomen. Appendicitis is the most common reason for a child to need emergency abdominal surgery. Young people between the ages of 11 and 20 are most often affected, and most cases of appendicitis occur in the winter between October and May. A family history of appendicitis may increase a child’s risk for the illness, especially in boys. Having CYSTIC FIBROSIS also increases a child’s risk for appendicitis.
The inside of the appendix usually opens into the large intestine. When the inside of the appendix is blocked by a piece of stool or something that a child swallowed, the appendix becomes swollen and easily infected by bacteria. If the infected appendix is not removed, an abscess may form and eventually burst or perforate. This may happen as soon as 48 to 72 hours after symptoms begin.
In older children, the classic symptoms of appendicitis are abdominal pain, fever, and vomiting. Abdominal pain usually begins in the center of the abdomen near the navel; often the pain then moves down and to the right, roughly where the appendix is located in the lower right part of the abdomen. After the abdominal pain begins, children with appendicitis usually develop a slight fever, lose their appetite, and may vomit. The fact that abdominal pain begins before nausea and vomiting instead of after is one clue to suspect appendicitis rather than an intestinal infection.
Other symptoms that may be seen in older children with appendicitis include diarrhea (small stools with mucus), urinating often or having an uncomfortably strong urge to urinate, constipation, and sometimes breathing problems.
In children younger than age two, the most common symptoms are vomiting and a bloated or swollen abdomen. There may be abdominal pain, but children may be too young to describe this pain. Because appendicitis is rare in infants, and their symptoms are not “classic,” the diagnosis of appendicitis is often delayed.
Correctly diagnosing appendicitis can be difﬁcult, since symptoms may mimic many other more common conditions, such as gastrointestinal infections. Even the most experienced physicians and surgeons are not able to diagnose appendicitis 100 percent of the time. Children between ages ﬁve and nine with appendicitis are often misdiagnosed with either gastroenteritis or a respiratory infection, which are much more common illnesses in this age group.
A diagnosis of appendicitis is made based on a physical examination, together with tests of blood and urine. To help support or eliminate the diagnosis, a doctor may also order X rays of the abdomen and chest. No laboratory test is speciﬁcally designed to identify appendicitis. Instead, surgeons are beginning to rely on CT scans of the appendix to conﬁrm appendicitis when the diagnosis is not clear. Ultrasound tests are even more accurate in correctly diagnosing appendicitis.
If appendicitis is not treated, the infected appendix may break open and spread the infection to the rest of the abdomen. If perforation does occur, the child’s abdominal pain may spread out to involve the whole abdomen, and fever may spike. Once symptoms of appendicitis begin, it takes as little as 24 hours for an infected appendix to perforate. Perforation with appendicitis is more common with younger children. It is a life-threatening complication.
Appendicitis is a medical emergency that must be treated surgically; it cannot be treated at home. A child with a suspected case of appendicitis should see a doctor immediately. Since the doctor will need to examine the child’s abdomen for signs of pain and tenderness, no pain medication should be given without a doctor’s permission. If there is a suspicion of appendicitis, no food or liquids should be given as possible preparation for surgery.
The decision whether to operate or not is most often based on history and physical exam. Surgeons have the option of removing a child’s appendix either through the traditional abdominal incision, or by using a small surgical device called a laparoscope to create a smaller opening in the abdomen. However, if the appendix has perforated, surgery becomes more complex and the risk of complications increases.
If the appendix is removed surgically before it perforates, complications are rare. After the surgery the child usually must remain in the hospital between one and three days. Even if the appendix has not perforated, the doctor may prescribe antibiotics to decrease the risk for wound infection after surgery.
However, if the infected appendix perforates, a longer hospital stay is needed.
There is no way to prevent appendicitis. Although appendicitis is rare in countries where people eat a high-ﬁber diet, experts have not yet proven that a high-ﬁber diet deﬁnitely prevents appendicitis.