Appendicitis is one of the primary causes of childhood surgery and if parents cannot recognize the symptoms quickly, it can lead to a great deal of pain for children and fear for parents.
What is the Appendix? The appendix is a small pouch, about 4-5 inches long, that rests on the front, right side of the body and connects to the large intestine. The appendix is an organ that most physicians believe serves no function because of the lack of symptoms after removal. Researchers theorize that the appendix might be an organ that can reboot the immune system with healthy bacteria after a bout of infection in the digestive system.
How Does the Appendix Become Infected?
When bacteria is trapped in the appendix, the organ becomes inflamed due to antibodies flooding the organ in the hopes of fighting off dangerous infections. Trapped bacteria can be the result of a hard collection of stool or by pressure on the lymph node in the groin. When the bacteria in the appendix are blocked from leaving, the appendix becomes irritated. This is usually when the abdominal pain begins in children.
What are the Symptoms of Appendicitis?
Early Symptoms: An early symptom of appendicitis is pain, often in the center of the abdomen but sometimes on the right side. The pain may be dull at first but may become more sharp or severe. Accompanying symptoms may include slight fever (above normal but less than 100 degrees), vomiting or nausea. Some individuals, particularly children, experience loss of appetite.
Later Symptoms: As the condition progresses, severe pain is usually felt in the lower right part of the abdomen. As the appendix becomes further inflamed, symptoms may include:
- severe or worsening pain or cramping in the abdomen, rectum or back
- swelling or tenderness in the abdomen
- severe nausea or vomiting
- high fever (over 100 degrees)
- diarrhea or constipation
- inability to expel gas
Appendicitis can be difficult to diagnose because a number of other conditions can cause similar symptoms. Not everyone with appendicitis exhibits all of these symptoms. If you or your child have any of these symptoms, particularly abdominal pain that continues to worsen, contact your doctor immediately.
If the appendix pain is left untreated, the organ will fill with pus and bacteria causing it to rupture. A ruptured appendix will cause extreme abdominal pain along with other symptoms such as fever, vomiting, loss of energy and appetite and will need urgent medical attention. If your child is complaining of persistent stomach ache or pain and it hurts to touch their right side of their body, you can be almost sure that their appendix is infected and needs to be removed.
Appendicitis in children is often the child’s first experience with any kind of surgery. Broken bones, falls and accidents are more typical reasons why children seek urgency medical attention, so if you can recognize that your child is displaying the symptoms of appendicitis, they will be understandably frightened. Try to keep them as calm as possible until a physician can see them.
How is Appendicitis Diagnosed?
A physician or other healthcare provider will perform one or all of the following tests to determine the extent of the appendix infection.
- Often, they’ll begin with a physical examination by pressing gently on the area and checking the child’s vitals.
- After that, an ultrasound will be performed on the child. Ultrasounds use the power of sound waves in order to image the interior of the body. Ultrasounds are totally painless and can help doctors determine the extent of the infection and whether it can be treated and minimized with antibiotics or if surgery is necessary.
- They may also recommend having a CT scan performed to determine the presence of appendicitis in children. CT scans (also known as CAT scans) use the power of X-rays and computer software to create cross-sectional images of the organs and soft tissues of the body. CT scans can be extremely beneficial in pediatric appendicitis cases in order to rule out other causes of abdominal pain like injury or bleeding.
- An MRI may be used to help diagnose or evaluate symptoms associated with appendicitis because it is non-invasive, fast, and does not use ionizing radiation.
- In some cases, an abdominal or chest x-ray may be the initial imaging study. Constipation and sometimes even pneumonia may be causing abdominal pain similar to that seen with appendicitis.
How is Appendicitis Treated?
There are three treatment options for appendicitis in children:
- Removal of the appendix with surgery. Small incisions and laparoscopy are usual methods to remove of the appendix. The child will stay in the hospital for 1-2 days and be discharged with antibiotics.
- If the appendix is ruptured, surgery is needed immediately. Once the appendix is removed, the child will have to stay in under hospital observation for several days — possibly longer than a week to monitor infection or fever.
- Interval appendectomy is treating an appendix infection with antibiotics. As the infection subsides, surgery becomes more an option rather than a necessity.