Appendicitis Information

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Appendicitis

An acute inflammation of the appendix, a narrow, worm-shaped structure positioned near thejunction of the small and large intestines in the right-lower corner (called a quadrant) of the abdomen.Appendicitis is the most common reason for abdominalsurgery in children.

The first symptom is usually cramping pain in themid-upper abdomen that gradually moves downwardand to the right while becoming more constant as in-flammation intensifies. Loss of appetite, nausea, andvomiting commonly occur as well. Appendicitis has sev-eral different pain patterns, especially in children.Sometimes younger children do not pay attention to (or are tillable to describe) the shift in location of pain fromone area to the other, especially when they are not feeding well. Older children may be more cooperative andbetter able to describe the location and characteristics ofthe pain.

Fever may develop as infection and inflammation ofthe appendix become more severe. If the appendix isnot censored, it will likely rupture. The infection con-tained within it can then spread into the abdominal cav-ity, resulting in inflammation of the inner lining of theabdomen - a condition called peritonitis. When thisoccurs, pain worsens and the child becomes increas-ingly ill.

In children with appendicitis, the time from the first symptom (typically, cramping pain and/or nausea) to rupture of the appendix is usually less than 36 hours. Because the symptoms of appendicitis are much more difficult to identify in children younger than two years ofage, the likelihood of rupture in this age-group is almost 100 percent. The frequency of rupture is much loweramong older children because they can usually commu-nicate their symptoms more clearly, allowing for an ear-lier diagnosis.

No single test can establish or exclude appendicitis100 percent of the time. The diagnosis is made by evalu-ating the child's history, a physical examination, labora-tory results, and usually some form of imaging (X-rayand/or ultrasound). A blood count, urinalysis, and pos-sibly other laboratory studies will be ordered. StandardX-rays of the abdomen may be taken, primarily to helprule out other conditions. Over the past few years, ultra-sound has been very useful in diagnosing appendicitis.If your child's doctor or an emergency-room physi-cian suspects appendicitis, a surgeon will be consulted.(In some areas, family physicians perform appendec-tomies, in which case a surgeon would not be called.) Ifthe surgeon agrees with the diagnosis, surgery is per-formed as soon as possible in an attempt to remove theappendix before it ruptures. This can prevent a muchmore severe illness, prolonged antibiotic treatment inthe hospital, and longer postoperative recovery.

If the doctor feels that the appendix has already ruptured, theoperation might be delayed for a number of hours to al-low for the administration of antibiotics and intra-venous fluids. If the surgeon is not sure of the diagnosis,he or she may observe the child for a period of time.Sometimes surgery for suspected appendicitis revealsa normal appendix. This is not evidence of bad medicaljudgment, because other conditions can mimic the painof appendicitis. One common example is a conditioncalled mesenteric adenitis, in which lymph nodes insidethe abdomen (especially near the appendix) become enlarged, inflamed, and painful, in a manner similar to an inflamed appendix. Even if a normal appendix is found, it will be removed for three (1) the appendix has no proven function of imp,"to human health; (2) if it is left in the patient, it become infected at some time in the future; (3) the appendix were left in and the patient's memo, wia.faulty, a doctor evaluating the problem would sc to:scar and could mistakenly assume that the appenda. megone - leading to a potentially disastrous misdiagrofu,If the appendix did not rupture, the child will nudismleave the hospital in one to three days. If it did, hospitalization may continue for another five to or more to continue intravenous antibiotics.

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