What is appendicitis?
If your child has appendicitis they may exhibit sudden abdominal pain, loss of appetite, nausea and vomiting, excessive gas or inability to pass gas, fever, diarrhea or constipation.
The appendix is a small organ joined to the large intestine and located in the lower right of the abdomen. People used to think the appendix served no useful function, but now we know it impacts the immune system by storing beneficial gut bacteria.
Most people only think about the appendix in terms of appendicitis. Appendicitis is an inflammation of the appendix that is usually caused by an infection or blockage. Anyone can develop appendicitis but it's most common in children and adults aged 10 to 30. If it isn't treated, the appendix might rupture, which can cause serious infection or death. Appendicitis in kids is treated with surgery to remove the appendix. If you suspect your child has appendicitis, you should have them treated immediately.
Symptoms of appendicitis
Children with appendicitis can have many symptoms, including any of the following:
- Sudden pain on the right side of the abdomen
- Abdominal pain that is worse if your child moves
- Abdominal pain that gets worse with time
- Abdominal pain that wakes your child from sleep
- Loss of appetite
- Nausea and vomiting
- Excess gas or an inability to pass gas
- Fever
- Diarrhea or constipation
Causes of appendicitis
The cause of appendicitis is not always clear, but it's usually related to one of the following:
Infection
Infection is one of the most common causes of appendicitis in kids. A viral or bacterial infection can cause your child's appendix to be blocked with pus and become inflamed. An inflammation blocks blood flow to the appendix and can cause the appendix to leak or rupture.
Blockage
Sometimes appendicitis can be caused by stool blocking the appendix. The appendix is normally open to the large intestine but it can become blocked with stool or bacteria. The blockage can cause inflammation and swelling.
Inflammatory bowel disease
If your child has an inflammatory bowel disease such as Crohn's disease and ulcerative colitis, it may cause appendicitis. The chronic inflammation from these types of diseases can lead to inflammation of the appendix.
Abdominal trauma
It doesn't happen very often, but if your child has had abdominal trauma, it can cause a blockage of the appendix. This could lead to appendicitis.
Tumors
Another rare cause of appendicitis is tumors, which can be both cancerous or non-cancerous, or benign. Tumors like these are usually discovered during an appendectomy or during imaging tests for other issues.
When to see the doctor for appendicitis
Appendicitis requires urgent treatment. If your child has any symptoms of appendicitis, call the pediatrician or go to the emergency room immediately.
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Diagnosing appendicitis
Your child's doctor may do any of the following if appendicitis is suspected:
Physical exam
If your child displays symptoms of appendicitis, the doctor will conduct a physical exam. If the doctor gently presses on your child's stomach and the pain worsens when the pressure is lifted, that can be a sign that the lining of the abdomen, the peritoneum, is inflamed. The doctor will also check to see if your child's abdominal muscles stiffen with pressure or show any signs of rigidity. The doctor will check for the Rovsing sign, which is present when pressure on the left side of your child's abdomen increases the pain on the right side.
Blood tests
A high white blood cell count (CBC) can indicate infection, so your child's doctor will do a blood test for this.
Urinalysis
Your child's doctor will test a specimen of their urine to check for a kidney stone or a urinary tract infection. Abdominal pain can be a symptom of these problems as well.
Imaging studies
After doing some other tests, your child's doctor will probably order some imaging studies to confirm appendicitis. A test such as an X-ray, ultrasound, magnetic resonance imaging (MRI), or computerized tomography (CT) can help determine if your child's symptoms are caused by appendicitis or another medical issue.
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Treatments for appendicitis
Surgery and antibiotics are the standard procedures for treating appendicitis. If your child has a very mild, uncomplicated case, it may be treated with only antibiotics, but this is not the usual course of treatment.
In some cases, your child will need to have an appendectomy. An appendectomy, or removal of the appendix, is done with one of the following methods:
Laparoscopy
This is the least invasive procedure for removing the appendix. It has fewer complications and requires a shorter recovery time. If possible, your child's doctor will probably do this type of surgery. It's performed with several small incisions in the abdomen.
Laparotomy
This is also called an open appendectomy. It may be required if your child's appendix has already burst or if there is an abscess that needs to be drained before the appendix can be removed. A laparotomy is performed with a larger incision in the lower right side of the abdomen.
For either surgery, your child will have to spend one or two days in the hospital and will then be sent home to finish recovering. Laparoscopic surgery will only require 3 to 5 days to heal from, but your child will need 10 to 14 days to recover from an open appendectomy.
Make sure your child gets a lot of rest and avoids any strenuous activity. Report any concerning symptoms to your child's doctor.
