Division of Pediatric General, Thoracic and Fetal Surgery

Appendicitis / Appendectomy

What is appendicitis?
How is it diagnosed?
About the appendectomy
After the operation
Caring for your child at home
When to call the doctor

What is appendicitis?

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.

How is it diagnosed?

It's sometimes difficult to diagnose appendicitis, because not every child will exhibit the same symptoms. If your child has appendicitis, she may have:

• Pain around the bellybutton, which then moves to her lower right side
• Vomiting
• Fever

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.

If your child has appendicitis, she'll need an appendectomy, an operation to remove the appendix.

About the appendectomy

Your child's surgeon will perform the appendectomy in one of two ways, depending on your child's needs.

• In the laparoscopic method, the surgeon will make three small (less than 1 inch) incisions in the belly, and then insert a small scope — which is like a miniature camera on the end of a long tube — through one of the incisions. He puts air through the tube so he can get a good view through the scope, then puts tools through the other two incisions to grasp and remove the infected appendix. After that, the surgeon closes the bowel and the small incisions with dissolving stitches, then puts surgical tape or glue over the incisions.
• If the surgeon performs an open appendectomy, she'll make a small (1 to 2 inches) incision in the right lower part of your child's belly, then carefully find and remove the appendix. After that, she'll close the bowel and the incision with dissolvable stitches, then cover the incision with surgical tape or glue.

After the operation

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.

If your child's appendix hasn't burst (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.

If the appendix has burst (ruptured):

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.

Caring for your child at home

Once your child is home, she can slowly return to "normal life":

• Start slowly with easily digested food, such as soup, toast, baked chicken and cereals.
• Treat any pain with acetaminophen (children's TYLENOL), every four hours. If your child needs a stronger pain medication, her doctor will give you a prescription.
• Let her rest. Even children who are normally very active may want to take a nap during the day. This is normal. She'll return to her normal activity when she feels better.
• Care for the incision as directed. If your child's incision is closed, the surgical tape or glue over it will fall off on its own.
• Follow the surgeon's or nurse's instructions on when your child may resume showering or bathing.
• Keep her out of the gym — and sports — until after her follow-up visit with the surgeon.
• See the surgeon for a follow-up visit two to four weeks after surgery. Your child's surgeon or nurse will let you know when your child needs to be seen.

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.

When to call the doctor

Be sure to call your child's doctor (at Children's Hospital, you should call 215-590-2730) if:

• Your child develops a fever that's higher than 101 degrees orally (by mouth)
• Your child begins vomiting
• The wound becomes red or swollen or has green or yellow drainage
• You notice different or more drainage when you change your child's dressings
• Your child's pain gets worse or isn't relieved by acetaminophen
• Your child seems sluggish
• Your child's appetite worsens
• You have any questions or concerns
• Abdominal swelling

Reviewed by: Surgical Advanced Practice Nurses
Date: November 2008