Appendicitis in Children
Overview
Appendicitis is a painful swelling,
inflammation, and infection of the appendix. It's a medical emergency because the
appendix can burst or rupture. This is serious and can lead to more widespread
infection. If not treated, it can be fatal.
The appendix is a thin,
finger-shaped tube that is joined to the large intestine. It sits in the lower right
part of the belly (abdomen). Experts don’t know for sure what role the appendix has
in
the body. It's not a vital organ. Removing it is not harmful.
Surgery to remove the appendix is
called an appendectomy. It's the most common type of emergency surgery for children.
Most children recover with no long-term problems.
Causes
Appendicitis happens when the
inside of the appendix is blocked by something, causing an infection. The blockage
may
be caused by mucus, stool, or parasites. Or the blockage may be caused by a bend
or
twist in the appendix itself.
The appendix then becomes sore and inflamed or swollen. This is because the germs
(bacteria) in the appendix begin to increase quickly. As the swelling and soreness
get worse, the blood supply to the appendix is cut off.
All parts of the body need the right amount of blood flow to stay healthy. When blood
flow is reduced, the appendix starts to die. The appendix will burst or rupture as
its walls start to get holes. These holes let stool, mucus, and other substances leak
through and get inside the belly or abdomen. A serious infection called peritonitis
may occur in the belly when the appendix bursts. If not treated, it can be fatal.
Risk Factors
Most cases of appendicitis happen between the ages of 10 and 30 years. Children with
cystic fibrosis may have a greater risk. Having a family history of appendicitis may
also increase a child’s risk for this condition.
Symptoms
Each child’s symptoms may vary. Below are some common symptoms of appendicitis.
Pain in the belly (abdomen) is the most common symptom. This pain:
- May start in the area around the
bellybutton and move to the lower right-hand side of the belly. Or it may start in
the lower right-hand side of the belly.
- Often gets worse as time passes
- May be worse when the child is moving, taking deep breaths, being touched, or coughing
and sneezing
- May be felt all over the belly if the appendix bursts
Other common symptoms include:
- Upset stomach (nausea) and vomiting
- Loss of appetite
- Fever and chills
- Changes in behavior
- Trouble having a bowel movement (constipation)
- Loose stool (diarrhea)
- Swollen belly in younger children
Diagnosis
Your child’s healthcare provider will take a health history and do a physical exam.
The provider may also order tests, including:
-
Abdominal ultrasound. This imaging
test uses high-frequency sound waves and a computer to create images of blood
vessels, tissues, and organs. It's used to see internal organs as they work.
-
CT scan. This imaging test uses both
X-rays and computer technology to show detailed images of any part of the body. This
includes the bones, muscles, fat, and organs. It's more detailed than a general
X-ray.
Other tests may include:
-
Blood tests. These tests check for infection and inflammation. They can also see if there are any
problems with other abdominal organs, such as the liver or pancreas.
-
Urine test. This test can tell if there is a bladder or kidney infection, which may have some
of the same symptoms as appendicitis.
Symptoms of appendicitis may look like other health problems. Always see your child’s
healthcare provider for a diagnosis.
Treatment
Treatment will depend on your
child’s symptoms, age, and general health. Appendicitis is a medical emergency. It's
likely the appendix will burst and cause a serious, deadly infection. For this reason,
your child’s healthcare provider will likely advise that your child have surgery to
remove the appendix. Your child may be given antibiotics and fluids through an IV
(intravenous) line before surgery starts.
Surgery is the most common treatment for appendicitis. But for some children, the
healthcare provider may give antibiotics instead of surgery.
The appendix may be removed in two
ways:
-
Open or traditional surgery. Your child is given anesthesia. A cut or incision is made in the lower right-hand
side of the belly. The surgeon finds the appendix and removes it. If the appendix
has burst, a small tube or shunt may be placed to drain out pus and other fluids from
the belly. The shunt will be taken out in a few days, when the surgeon feels the infection
is gone.
-
Laparoscopic surgery. Your child is
given anesthesia. This method uses a few small incisions and a camera called a
laparoscope to look inside the belly. The surgical tools are placed through 1 or more
small incisions. The laparoscope is put in through another incision. This method is
not usually done if the appendix has already burst.
Interval appendectomy
Sometimes the appendix bursts, and a collection of infected fluid or pus (abscess)
may form. If this happens and your child is stable, the provider may recommend not
removing the appendix right away. Instead, the provider may want to treat the infection
first and drain the infected fluid from the abscess. The appendix will be removed
later. This delayed surgery is called an interval appendectomy.
For an interval appendectomy,
your child will be given IV antibiotics. These are given through an IV tube called
a
PICC line, or a peripherally inserted central catheter. This stays in place about
10
to 14 days. The provider may also use CT or ultrasound-guided images to drain the
abscess. Once the infection and inflammation are gone, your child will have surgery
to remove the appendix about 6 to 8 weeks later.
After surgery
A child whose appendix ruptured will have to stay in the hospital longer than a child
whose appendix was removed before it burst. Some children will need to take antibiotics
by mouth for a certain period of time after they go home.
After surgery, your child will
not be allowed to eat or drink anything for a certain period of time. This lets the
intestine heal. During this time, fluids, antibiotics and pain medicine will be given
by IV into the bloodstream.
As the healing progresses, your
child will be able to drink clear liquids, such as water, sports drinks, or apple
juice. and will gradually move on to soft then solid foods.
After your child leaves the
hospital, the healthcare provider will likely limit their activities. Your child
should not do any heavy lifting or play contact sports for a few weeks after surgery
or as directed. If a drain is still in place when your child goes home, they should
not take a bath or go swimming until the drain is removed.
You will be given a prescription for pain medicine for your child to take at home.
Some pain medicines can make a child constipated, so ask your healthcare provider
or pharmacist about any side effects. Moving around after surgery rather than lying
in bed can help prevent constipation. Drinking fruit juices may also help. Once your
child can have solid foods again, eating fruits, whole grain cereals and breads, and
vegetables can also help stop constipation.
Most children who have their appendix removed will have no long-term problems.
Complications
An irritated appendix can quickly turn into an infected and ruptured
appendix. This can happen in a few hours. A ruptured appendix is an emergency situation.
If not treated, it could be fatal. When the appendix ruptures, germs (bacteria) infect
the organs inside the abdominal cavity. This causes a bacterial infection called
peritonitis. The bacterial infection can spread very quickly. It may be hard to treat
if
diagnosis is delayed.
When to Call a Healthcare Provider
An infected appendix can burst or rupture. This is an emergency and
could be fatal. call your child’s provider and go to the emergency room right away
If
your child has the symptoms of appendicitis listed above, .
Key Points
- Appendicitis is a painful swelling and
infection of the appendix. It's a medical emergency.
- The appendix can burst or rupture, causing more infection. If not treated, it can
be fatal.
- Healthcare providers will likely recommend that the child’s appendix be removed.
- An appendectomy is the most common type of emergency surgery for children.
- Most children recover with no long-term problems.
Next Steps
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.