When Your Child Has Appendicitis

The appendix is a small, hollow piece of tissue attached to the colon (large intestine) where it meets the small intestine. It is usually located below and to the right of your belly button. An inflammation or infection of the appendix is called appendicitis. Surgery is most often needed right away to remove an inflamed or infected appendix. Your child's doctor will tell you more about your child’s condition. They will tell you what your choices are.

The appendix

The appendix is attached to the beginning of the large intestine (colon). Waste moves through the colon and passes in and out of the appendix. In some cases, waste can be trapped inside the appendix. This can occur due to an obstruction or blockage caused by stool (feces) or a small, hard piece of stool (fecalith), a foreign body, a tumor, or, in rare cases, even worms. When the appendix contains trapped waste or bacteria, an infection can develop. An infected appendix can swell and then burst (rupture). This can be very dangerous. This is why surgery is often done right away to remove the appendix before it bursts. Sometimes an appendix bursts and a pocket of infection (abscess) forms. This needs to be drained. Antibiotics may need to be given for some time (can be weeks) before the appendix is removed. 

Surgery is needed to remove an infected appendix before it ruptures.

What are the symptoms of appendicitis?

Symptoms can appear very quickly. They may happen in a few hours or in 1 to 2 days. They may include:

• Pain that starts in the center of the belly (near the belly button) and with time moves to the lower right side. Also, the pain:

  • Becomes sharper with time.

  • Gets worse with walking.

  • Gets worse when your child moves around, takes deep breaths, coughs, or sneezes.

  • Wakes your child from sleep.

• Upset stomach or vomiting.

• Low appetite.

• Fever.

• Extreme tiredness (fatigue).

• Loose, watery stool (diarrhea) or hard, dry stool (constipation).

• Urinary frequency or urgency.

How is appendicitis diagnosed?

An exam will be done to find the source of your child’s pain. Tests may be done if needed. They include blood tests, urine tests, and imaging tests.

• Blood tests. These include total white blood count, neutrophil percentage, and C-reactive protein concentration. There is no definitive blood test for appendicitis.

• Urine test. This test looks for any signs of urinary tract infection or a kidney stone.

• Imaging tests. A test that takes a picture of the belly may be done. This might be an abdominal ultrasound, or MRI. A CT scan may be recommended only after ultrasound and MRI.

How is appendicitis treated?

Surgery is done to take out the appendix. This is called an appendectomy. It may be done in 1 of 2 ways:

• Open surgery. A single cut (incision) 2 or 3 inches long is made in the lower right part of the belly. If the appendix has burst, the cut may need to be bigger.

• Laparoscopic surgery. Between 1 and 4 small cuts are made in the belly. A thin, lighted tube with a camera (laparoscope) is used. It is put through 1 cut. It shows the inside of the belly on a screen. Tools are put into the other cuts. In some cases, the surgeon may need to change a laparoscopic surgery to open surgery for your child's safety.

The cuts will be closed with glue, stitches, or staples. A tube (known as a drain) may be used for a short time. This is done to drain fluid so it does not build up and cause problems. If the appendix has burst, the cut may be left open. This lets it drain more easily. It may heal on its own. Or it may be closed 4 or 5 days later.

Your child’s recovery

Your child will likely stay in the hospital for 1 to 2 days. If the appendix has burst, the stay may be a week or more. During this time:

• Your child will be given medicine to help ease pain.

• Fluids may be given through an I.V. (intravenous) line.

• Antibiotics may be given to prevent or fight infection.

• Antinausea medicine may be given to control throwing up.

• Your child will be given only liquids at first. This is to let the colon heal. Solid food is then slowly started again.

After your child gets home:

• Don't let your child do any heavy lifting, contact sports, swimming, or rough play for 3 to 4 weeks. Once the cuts heal, your child can go back to all activities.

• Keep the incision site clean and dry for a few days after surgery. Follow your doctor's instructions about wound care.

• Ask your doctor when it's OK for your child to shower or bathe.

• Visit your child's doctor for a follow-up consultation, as scheduled.

When to contact your child's doctor

Contact your child's doctor if:

• Your child has signs of infection at the cut site. This includes swelling, drainage, pain that gets worse, or abnormal redness.

• Your child has a fever of 100.4°F (38°C) or higher, or as advised by the doctor.

• Your child has belly pain that gets worse.

• Your child has severe diarrhea, bloating, or constipation.

• Your child has an upset stomach or vomiting.