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Pediatric Appendicitis

Child experiencing abdominal pain from appendicitis

What is appendicitis?

Appendicitis is caused when food and stool gets trapped in the appendix causing it to become inflamed. Appendicitis often starts as stomach pain, most commonly found in children.

Appendicitis typically requires the removal of the appendix to avoid further damage in the abdomen and other parts of the body. An appendix can rupture within 24 hours. If your child is experiencing abdominal pain, seek medical care immediately.

Who can get it and who is at risk?

Appendicitis often starts as stomach pain, most commonly found in children aged 4-15 years old. Although, appendicitis can happen to anyone at any age. Anyone who hasn’t had an appendectomy is at risk.

What are the symptoms of appendicitis?

It is the number one surgical emergency that involves acute abdominal pain if the patient has never had a prior appendectomy. The symptoms associated with appendicitis include:

  • Sharp pain in lower right stomach area
  • Pain around the belly button that moves lower
  • Loss of appetite
  • Nausea and vomiting
  • Stomach may appear swollen or distended, and the child may not be able to pass gas or is constipated.
  • Fever between 99-102° F. If you notice a fever, take take your child to the emergency department because this is a sign the infection is progressing.

If your child has symptoms of appendicitis, don’t use heating pads, laxatives, or enemas. These methods will not relieve symptoms and can make the infection worse.

How is appendicitis diagnosed?

Appendicitis is caused by an obstruction of the appendix due to inflammation of the appendix wall. It can also be caused by hard stools called fecaliths, or by calcified deposits called appendicoliths.

There are a variety of tests and procedures to diagnose appendicitis. The first is a physical exam to assess your pain. The doctor will apply gentle pressure, and the appendix pain will often feel worse when the pressure is released. This probing lets the doctor know that the tissue lining the abdominal wall is inflamed.

The doctor may also check for guarding of the appendix. Guarding is when the abdominal muscles stiffen in response to the pressure on the appendix. The last physical test is a digital exam of the lower rectum.

When it comes to blood tests, the doctor will look for high white blood cell counts to determine if there is an infection. They may also recommend a urinalysis to rule out a urinary tract infection or kidney stones.

A CT scan is usually the most accurate way to diagnose appendicitis. However, your doctor may recommend other imaging tests like an abdominal x-ray, ultrasound, or an MRI as well.

When is surgery needed?

Surgery is needed when the doctor suspects the appendix has burst or is about to become perforated.

Before the surgery, your child will be given a round of antibiotics to treat the infection. If the appendix ruptures prior to surgery, the doctor may place a tube into the abscess to drain the excess fluids and control the infection before starting surgery. After the surgery, your child may be tired from the general anesthesia and medications. However, that will wear off within a few hours post surgery. If it doesn’t go away, follow up with your doctor.

What can I expect from an appendectomy?

There are generally two types of surgeries used to remove an appendix. The first type of appendectomy is an open surgery that requires a 2-4 inch incision. This surgery is called a laparotomy.

Another type of surgery that is less invasive is a laparoscopic appendectomy. The surgeon makes a few small incisions and inserts a video camera and special surgical tools to remove the appendix. This method allows the patient to recover faster and heal with fewer scars and less pain.

Unfortunately, a laparoscopy doesn’t suit every situation. If the appendix has ruptured and the infection has spread throughout the abdomen, an open appendectomy is used so that the surgeon can clean the abdomen and infection fully. It’s important to know the signs of an infection in case one develops post-surgery. The signs that your incision is infected may include red, weeping, or swollen flesh around the incision.

Recovery After Surgery

Expect your child to be hospitalized for one to two days after surgery. In order to return home, your child must hold an average temperature, can eat and drink on their own, and be able to take medications by mouth. Once home, your child’s recovery should only last two to four weeks, before they are back to their normal activities. However, they should start slow with getting out of bed and walking before beginning more vigorous activities.

Your child will receive a prescription for pain medication. They may also take acetaminophen and ibuprofen if their doctors permit. The pain and soreness from the surgery is usually best managed with over-the-counter medications. In the weeks after your child's surgery, keep an eye out for signs of pain, or other indications your child is not healing correctly. These signs may include:

  • Fever over 101° F
  • Incision looks red and swollen or is draining fluids
  • Increased abdominal pain
  • Loss of appetite
  • Runny noses, earaches, rashes, coughs, and sore throats
  • Vomiting and diarrhea