Appendicitis is an infection of the appendix, the finger-shaped structure at the end of the large intestine, in the right lower part of the abdomen. Children of any age can get appendicitis.
It's sometimes difficult to diagnose appendicitis, because not every child will exhibit the same symptoms. If your child has appendicitis, she may have:
If your child has these symptoms, you should take her to the doctor's office or emergency department. She may need blood tests and special radiology tests, such as X-rays, Ultrasound, or CT scan, to confirm the diagnosis. The doctor may perform a rectal exam. If your child needs fluids or antibiotics, she'll receive an IV (intravenous line), as well.
Your child's surgeon will perform the appendectomy in one of two ways, depending on your child's needs.
After your child's surgery is over, he'll go first to the recovery room, then to a regular hospital room. At first, he'll get pain medicine through an IV. When he's able to drink, he'll take his pain medicine (usually acetaminophen [TYLENOL] and oxycodone) by mouth.
The day after surgery (or in the evening, if her surgery was early in the morning), your child will need to get out of bed and begin to move around to help her heal faster. If your child had laparascopic surgery, the air the surgeon used may cause some crampy gas pains or shoulder pain. Walking and moving around will help relieve this pain, too. The care your child receives — and how soon he goes home from the hospital — will depend on whether his appendix ruptured.
She'll receive antibiotics through an IV for the first 24 hours after surgery. She may begin drinking clear liquids the morning after surgery. If her wound is healing well, she doesn't have a fever, and she's keeping liquids and food down, she may go home one to two days after her appendectomy.
During surgery, the surgeon may place a tube that goes from your child's nose to his stomach to drain fluids and prevent vomiting. After surgery, once your child begins passing gas or stool, the tube will be removed. Several hours later, he can begin drinking clear liquids. Not every child will need this tube and some will be able to eat soon after surgery.
Your child will need to stay in the hospital longer — from five to seven days — than someone whose appendix didn't burst, because the bacteria or stool that was inside his appendix is now in his abdomen. Your child will receive IV antibiotics during his hospitalization. Depending on how infected the appendix was, your child may have a drain left in his belly to remove any fluid or bacteria, and will get antibiotics to treat the infection. If the infection is serious, your child may need 10 or more days of antibiotics.
Some children will stay in the hospital for a complete antibiotic course. Others may go home on oral antibiotics or on antibiotics through a special IV. Occasionally, a child will develop a fever after the operation. His doctor will order more X-rays and labs to determine its cause. In some cases, an area of pus may still be in his abdomen because some of the bacteria and fluid from the burst appendix couldn't be completely removed. As a result, a temporary drain may need to be placed to drain the pus. The wound may be infected because the bacteria got into it, in this case, the wound may need to be reopened to let the bacteria out.
If your child's wound is healing well, the pain is controlled, he doesn't have a fever, and is keeping liquids and food down, he'll be able to go home after five to seven days.
Once your child is home, she can slowly return to "normal life":
If your child's appendix hasn't burst (ruptured), she may return to school two days after she comes home from the hospital. At first, half days may be best, especially if your child feels tired. If it her appendix has ruptured, she needs to wait until after her postoperative visit with the surgeon to return to school.
In addition, a child whose appendix ruptured may continue to need antibiotics and wound dressing changes. If this is the case, you'll receive instructions on how to care for your child, and you'll be put in contact with a home care nurse who will help you.
Be sure to call your child's doctor (at Children's Hospital, you should call 215-590-2730) if:
Reviewed by: Surgical Advanced Practice Nurses
Date: November 2008