Appendicitis occurs when the appendix (an extension of the large intestine) becomes inflamed and infected. The treatment is the surgical removal of the affected appendix. In some cases, when the appendix has already burst, surgery is performed after a period of antibiotic treatment. Appendicitis is the most common reason for abdominal surgery in childhood.
What is Appendicitis?
Appendicitis happens when the appendix, a small appendage of the large intestine, becomes swollen and infected. In many cases, a blockage in the appendix causes the infection, leading to bacterial overgrowth. In 20 to 30 percent of children, the appendix can rupture, releasing the infection into the abdominal cavity.
How Common is Appendicitis?
Appendicitis affects about 80,000 children annually in the United States. It is most common in the second decade of life. Approximately fifty percent of children will have a family history of appendicitis. It is the most frequent cause of abdominal surgery in children.
What are the Symptoms of Appendicitis?
Since the appendix is located in the lower right part of the abdomen, the most important symptom is abdominal pain. This often begins around the belly button and later moves to the lower right side. Other symptoms include:
- Nausea and vomiting
- Loss of appetite
- Low-grade fever
- Diarrhea (after several days)
- Pain during or increased frequency of urination
How is Appendicitis Diagnosed?
The main signs of appendicitis are a history of pain in the lower right abdomen, followed by vomiting, low-grade fever, and tenderness and rigidity (stiffness) in the same area.
Most patients will undergo imaging of the abdomen using ultrasound and/or a CT scan. Blood tests and urinalysis may also be performed.
No single test or finding is 100% accurate and reliable in diagnosing appendicitis. The doctor must gather all available information. In some cases, the only way to diagnose appendicitis is through surgery.
How is Appendicitis Treated?
The treatment involves the surgical removal of the affected appendix. In some cases, if the appendix has burst, surgery is performed after a period of antibiotic therapy.
During the Surgery
An anesthesiologist (a doctor who specializes in pain relief and sedation for children) will administer anesthesia to your child, inducing sleep. If a laparoscopic method (minimally invasive technique) is used, the surgeon will access the abdomen with small instruments and a camera inserted through various small incisions (cuts). Sometimes, a slightly larger incision is necessary to remove the appendix. The appendix is removed, and the infected fluid is flushed from the abdominal cavity. In some cases, drains may be placed to allow for the removal of infected fluid. The surgery typically takes less than an hour to complete.
After the Surgery
The usual hospital stay is 12-24 hours for uncomplicated appendicitis and 5 to 7 days for a ruptured appendix. Your child will receive intravenous (IV) pain medication and antibiotics during their hospital stay. Oral intake will begin slowly, usually starting with clear liquids. Your child will gradually progress to a normal diet. There may be a bandage over the incision.
Your child will be ready for discharge from the hospital when they can eat a normal diet, have no fever, the drain from the incision is not producing fluid, and they have normal bowel function.
What to Expect After Discharge from the Hospital Following Appendectomy
Most children will need a few days of rest at home before returning to school, and 2 to 4 weeks before resuming gym activities and sports, depending on the level of inflammation present.
When to Call Your Child’s Doctor
You may notice some slight swelling around the incision, which is normal. However, call the doctor if your child develops any of the following:
- Fever
- Vomiting
- Excessive swelling or redness at the incision site
- Bleeding
- Increased pain
Follow-Up Care
A follow-up outpatient visit will be scheduled one to two weeks after your child’s surgery. Your doctor will examine the wound and assess their recovery.