Pediatric Appendicitis

What is appendicitis?

Appendicitis is one of the most common complaints for abdominal pain in children. It is common in children from ages 4 to 15 years old; but can be seen in any age group. Appendicitis is an inflammation of the appendix. It is thought that appendicitis is due to various factors. One thought is that it may be due to blockage of stool which will form a stone (called a fecalith). Appendicitis can also result from enlarged lymph nodes caused by a viral infection. 

Once this blockage occurs, bacteria located within the appendix grow. The pressure in the appendix increases and the appendix becomes swollen. Eventually the blood vessels to the appendix close and the appendix dies; when this occurs "perforation" occurs which means the appendix ruptures.

Appendicitis should be treated according to the symptoms, examination, and if required an ultrasound or CT scan. If the diagnosis of appendicitis is made an operation called an appendectomy is required where the appendix is removed. Patients who present with ruptured appendicitis depending on their length of symptoms and condition may be treated with antibiotics followed by an interval appendectomy that is performed approximately 6-8 weeks later. 

How is appendicitis diagnosed?

Children with appendicitis usually first complain of pain around their umbilicus (belly button) and do not want to eat. The pain gradually moves to the right lower part of the abdomen. There may be associated nausea, vomiting and diarrhea. Some children have a fever but not always. 

The practitioner will begin by examining your child for other problems that can "look like" appendicitis. They will gently push on your child's abdomen to look for localized pain or tenderness. They may ask your child to move or jump up or down. After the physical exam, the practitioner will have blood drawn to look for an increase in the number of white blood cells which may indicate an infection. It is often also helpful to get an ultrasound or CT scan to help make the diagnosis. 

Appendectomy

The appendix can be removed via laparoscope through two or three small incisions or it can be performed through an open procedure using an incision. The benefit of laparoscopic appendectomy is that the incisions are smaller and the surgeon has the ability to completely see the other structures inside the abdomen.

In some cases, an open appendectomy (instead of with a laparoscope) is performed through a longer right lower abdomen incision. Intravenous antibiotics are continued after the operation in patients with complicated appendicitis and ruptured appendicitis. Patients can usually start eating following the operation and in most cases of uncomplicated non-ruptured appendicitis are discharged home within the first 24 hours. 

Diet

Your child may resume their regular home diet as tolerated once discharged home from the hospital.

Incision care/bathing restrictions

  • Leave the steri-strips (surgical tapes) or surgical glue in place until they fall off or the glue sloughs off on its own. The steri-strips are generally left in place for 7 to 10 days. 
  • Incisions should be kept clean and dry for 48 hours after surgery. After that time, your child may shower or take shallow baths/sponge baths and pat the incisions dry.
  • two weeks after surgery and when the incisions appear well healed the child may resume normal bathing and swimming
  • no swimming, chlorinated water, hot tubs or lake water for 2 weeks 

Activity restrictions

  • no driving while taking narcotic pain medication if provided
  • your child may use over the counter stool softeners for constipation while taking narcotic pain medication
  • your child should not participate in any vigorous physical activity, gym class, organized sports, heavy lifting or abdominal core work outs for 2-4 weeks as directed by your surgeon and dependent upon your child’s age/activity level

When to contact your surgeon

  • fever greater than 101 degrees
  • increased tenderness, redness, swelling, unusual drainage or foul odor from the incisions
  • unexplained increase in abdominal pain or pain not relieved by prescribed pain medication
  • nausea, vomiting, diarrhea or constipation which is not improving 

Contact information and hours

Our office is open Monday through Friday from 8:00 a.m. - 5:00 p.m. Please call us with any questions or concerns in regards to your child's post-operative care. Our office number is 248-551-2400. After office hours and on weekends or holidays, your call will be directed to our on call surgeon thru our answering service.