Division of Pediatric General, Thoracic and Fetal Surgery

A Guide to Your Child's Surgery

Our Surgery Guide will help you and your family prepare for your child's upcoming surgery, outlining what to expect from the first pre-op visit all the way through to her discharge.

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Appendicitis / Appendectomy

What is appendicitis?
How is it diagnosed?
About the appendectomy
After the operation
When to call the doctor

What is appendicitis?

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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.

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.

What causes appendicitis?

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.

What are the signs and symptoms of appendicitis?

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

How is appendicitis diagnosed?

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.

What is the treatment for appendicitis?

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:

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

Appendectomy

An appendectomy is a surgical procedure, performed under general anesthesia, to remove the appendix.

An appendectomy is the standard treatment for non-perforated appendicitis, and can also be used in the treatment of perforated appendicitis, alone or combined with other treatment options.

If your child has an appendectomy at The Children’s Hospital of Philadelphia, it can be done in two ways:

Learn more about what to expect on the day of your child’s surgery.

Your child’s recovery and follow-up care after his appendectomy will depend on if his appendix was perforated (ruptured) or non-perforated. Read on below for more information about what to expect after the operation.

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

After surgery for non-perforated appendicitis

If your child's appendix has not ruptured, he will remain hospitalized for 1 to 2 days after s. Your child will be able to drink when he has recovered from anesthesia. After tolerating liquids, he will be able to eat and drink whatever he would like. 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 may be discharged from the hospital with a prescription for pain medication.

After being discharged from the hospital, your child will be able to return to school when he is comfortable and no longer 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.

If your child’s appendix did not rupture, you will have the option of bringing him back for a post-operative visit or receiving a post-operative phone call from one of the surgical nurse practitioners 2 to 3 weeks after being discharged from the hospital. During the visit or phone call, the pathology of the appendix will be discussed with you.

After surgery for perforated appendicitis (burst appendix)

After surgery to remove a burst appendix, your child will remain hospitalized until he is without fever, tolerating food and drink by mouth, and comfortable using only oral pain medications. The length of hospitalization will be different for each child. Initially, your child will be on IV fluids until he is able to eat or drink. Your child will receive IV pain medications and antibiotics during this time.

Your child will be able to eat and drink as tolerated. When he is tolerating food and drink by mouth, both the pain medications and the antibiotics will be changed to the oral form. When your child is ready to be discharged, he may be sent home from the hospital with a prescription for pain medication and antibiotics.

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. Your child will return for a follow-up appointment in the General Surgery Clinic 2 to 3 weeks after being discharged from the Hospital.

If your child has perforated appendicitis, the treatment will depend on the degree of the infection. Your child may have one or more of the treatments described below.

When to call the doctor

Please call the General Surgery Clinic if your child following has any of the following:

Contact us

Please contact the Division of Pediatric General, Thoracic, and Fetal Surgery at 215-590-2730 with any questions.

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

Developed by: Mary Kate Klarich, MSN, CRNP, and Natalie Walker, MSN, CRNP
Reviewed by:
Joy Collins, MD
January 2014

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