Appendicitis

  • What is appendicitis?

    Appendicitis is an infection or inflammation of the appendix, a tube-like structure attached to the cecum (large intestine). The appendix is located in the right lower part of the abdomen in most children.

    anatomy of stomach

    Appendicitis is the most common cause of emergency abdominal surgery in children. Appendicitis can occur at any age, but it occurs more frequently in school-aged children (8 to 16 years old). It rarely occurs in children under the age of 1. However, the rate of perforation (rupture or burst appendix) is higher in younger children, as they cannot often describe their symptoms.

  • Causes

    Appendicitis is the result of a blockage of the appendix caused by hard mucus or stool, a foreign body, or virus. The blockage causes the appendix to swell and become inflamed. If the swelling and the infection are left untreated, the appendix can burst (perforate), causing the contents of the appendix to be released into the abdominal cavity and spreading the infection.

  • Signs and symptoms

    The signs and symptoms of appendicitis can vary from child to child. The most common symptoms are:

    • Abdominal pain that begins around the belly button and moves to the right lower side of the abdomen. The pain typically increases when walking, jumping or coughing, and usually worsens as time goes on.
    • Fever
    • Nausea and/or vomiting
    • Diarrhea
  • Testing and diagnosis

    Appendicitis is diagnosed with a thorough health history and physical examination. Your child may need to have an imaging study done, such as an ultrasound or CT scan, to let the doctors see the appendix. Your child may also have laboratory studies, such as a complete blood count (CBC), to determine the extent of the infection.

  • Treatments

    Patients diagnosed with appendicitis initially receive IV fluids and antibiotics. Ultimately, the treatment for appendicitis is surgery to remove the appendix. This procedure is called an appendectomy, and can be done in two ways: a laparoscopic appendectomy, or an open appendectomy. Appendectomies are performed under general anesthesia.

    The timing of this surgery can depend on many factors, such as:

    • Whether the appendix is non-perforated or perforated
    • The extent of the infection
    • The length of time your child has had symptoms

    If your child has perforated appendicitis (if the appendix has burst), the treatment will depend on the degree of the infection. Treatment approach may include one or more of the following: a laparoscopic appendectomy, an open appendectomy, medical management that includes long-term antibiotics and possibly a drainage procedure before the appendix is surgically removed.

    Medical management of perforated appendicitis

    If the surgeon caring for your child feels as though the infection is too severe to operate right away, your child will be treated with long-term antibiotics (usually about 2 weeks) before the appendix is removed. This allows for the infection to be treated, the inflammation to resolve and your child to heal. The antibiotics are usually given intravenously (IV) through a special IV catheter called a PICC line. In some cases, the antibiotics can be given orally.

    After antibiotic therapy, your child will be discharged when he is fever-free and eating and drinking a fair amount. A home care nurse may visit one to two times per week to check on your child. When your child has completed the prescribed antibiotics, the PICC line will be removed either in the General Surgery Clinic or by the home care nurse if your child is well.

    Your child will have a follow-up appointment in the General Surgery Clinic at which time your child’s surgeon will discuss which type of procedure will be used to remove your child’s appendix. This appointment will include a pre-operative examination to prepare for surgery. The appendix will typically be removed 4 to 6 weeks after completing the antibiotic therapy.

    Follow-up care is typically similar to that of children who underwent surgery for non-perforated appendicitis, and your child will return for follow-up in the General Surgery Clinic 2 to 3 weeks after being discharged from the hospital.

    Drainage procedure for burst appendix

    Sometimes when the appendix perforates (bursts), infected fluid is released and collects in the abdomen. This fluid collection often creates a “wall” around itself, becoming an abscess and making it harder for the antibiotics to treat the infection. In this case, the fluid must be drained in order to help the antibiotics treat the infection. This is done using an abdominal drainage procedure.

    In most cases, your child will remain hospitalized until the drain is removed. The length of time the drain is kept in place depends on the amount of drainage and your child’s physical exam.

  • Follow-up care

    Your child’s recovery and follow-up care after his appendectomy will depend on if his appendix was perforated (ruptured) or non-perforated.

    The length of hospitalization will be different for each child who is treated for appendicitis. In order to be discharged from the hospital, your child needs to be able to walk, eat and drink without vomiting, be without fever and have good pain control with the pain medicines prescribed.

    Your child will be able to return to school when he is comfortable and not taking the prescribed pain medication. This will be different for each child. Your child will not be able to participate in physical education or sports for 2 weeks after the procedure. Your child will also not be able to lift anything heavy; this includes a heavy book bag.

    We will arrange a postoperative follow-up appointment for 2 to 3 weeks after your child is discharged from the Hospital.

    Learn more about recovery and follow-up care after surgery.

  • When to call the doctor

    Please call us if your child following has any of the following:

    • Fever greater than 101.5 degrees F
    • Vomiting or unable to tolerate any food or liquids
    • Increasing or continuous abdominal pain
    • Abdominal distention
    • Drainage from incisions
    • Redness or swelling of the incisions
    • Any further questions or concerns

    Appendicitis is considered an emergent condition. If you think that your child may have appendicitis, please have him evaluated at the Emergency Department.

Reviewed by Mary Kate Klarich, MSN, CRNP, Natalie Walker, RN, MSN, CRNP, Joy L. Collins, MD, FAAP, FACS on January 31, 2014