Appendicitis is inflammation and infection of the appendix, a small tube-shaped piece of tissue attached to the large intestine. The appendix is located in the right lower abdomen (belly).
Appendicitis results from blockage in the appendix caused by dried mucus, hard stool, parasites or other foreign bodies. Mucus, which is secreted by the inner lining of the appendix, builds up behind the blockage when it can no longer drain into the large intestine. The blockage and build-up of mucus can impair blood flow through the appendix, and cause swelling and infection. Over time, this swelling and infection can cause the appendix to perforate (burst or rupture). If untreated, the infection can then spread and lead to peritonitis, an infection of other tissues in the abdomen.
Appendicitis is the most common cause of emergency abdominal surgery in children. It is slightly more common in boys and is rare in babies less than 1 year of age. Most cases occur between 8-16 years of age. The rate of perforation is higher in younger children (less than 5 years) because of their difficulty describing symptoms and difficulty examining them.
There is a wide range of symptoms and not all children have all symptoms. The most common symptoms include:
- Pain that usually begins in the center of belly, around the belly-button, and then moves downward and to the right, near the area of the appendix. This usually becomes worse as time passes, when moving, taking deep breaths, coughing, sneezing and being touched in the area. The location of the pain is often hard for preschool children to describe.
- Lack of hunger
- Nausea and vomiting
- Fever and chills
- Diarrhea or constipation
- Urinary symptoms such as urinating frequently and pain with urination
Treatment for appendicitis is removal of the appendix (appendectomy). Patients receive antibiotics both before and after surgery. If the appendix has not perforated, most children are able to go home from the hospital within 24-48 hours and are able to return to school in one week.
At times, when the appendix has perforated and the infection has localized to one area, an abscess forms. Treatment of the abscess includes drainage of the infection and a course of intravenous (IV) antibiotics. An appendectomy is then performed approximately 6-8 weeks after the infection has been treated.
A child with non-perforated appendicitis is generally in the hospital for one to two days following surgery. A child with perforated appendicitis is usually in the hospital for four to five days. The child must stay in the hospital until they are:
- Eating
- Passing gas
- No longer having high fevers
- Able to walk in the hallway
- Pain is managed with oral pain medications
Before the child is ready to go home, parents will be instructed about the antibiotics the child will need to receive at home. These antibiotics are sometimes given through a special intravenous (IV) line, and are sometimes given orally.
The wound site must be kept clean and dry for at least two days after surgery. Your child may take a shower two days after surgery. No tub baths should be taken for one week.
Your child’s pediatric surgeon should be called if any of the following problems occur:
- Your child’s temperature is above 101.5° F (38.6° C), even if it drops below this after acetaminophen is given
- Your child has significant bleeding from the incisions
- Your child has extreme swelling at the incision sites. It is normal for there to be a small amount of swelling present for a couple days after the procedure
- Your child’s incision looks infected. Symptoms of an infection include redness, significant swelling, pus (cloudy, yellow drainage) draining from site, increased tenderness or pain at site
- Pain is not relieved by medication
- Your child vomits or develops diarrhea after being discharged from the hospital
Children can live a normal life without an appendix, with no changes in diet, exercise, or lifestyle.