The appendix is a tiny, worm-shaped structure attached to the part of the bowel (large intestine) called the cecum. Appendicitis is swelling (inflammation) and infection of the appendix. It affects many children, most often those 11 to 20 years old and rarely babies. It’s the most common cause of emergency surgery in childhood. An infected appendix can rupture (burst open) and be life-threatening. With treatment, children usually have no long-term problems.
The exact cause is unclear. The opening from the cecum to the appendix becomes blocked (obstructed), which leads to inflammation and growth of bacteria. Infection prevents blood flow, gangrene begins, and the appendix can burst and cause an abdominal infection called peritonitis.
Obstruction can be caused by fecoliths (tiny pieces of undigested vegetable surrounded by stool) and enlarged lymph nodes caused by viruses, parasites, or tumors.
A family history of appendicitis (especially for males) and cystic fibrosis can mean higher risks.
Symptoms vary according to age. In children 2 years old or younger, the most common ones are vomiting, swollen abdomen (belly), and pain. The classic symptom is abdominal pain that starts around the belly button. Pain then moves down to the right lower corner of the abdomen. Moving, coughing, sneezing, taking deep breaths, and straining can make pain worse. Nausea, vomiting, loss of appetite, abdominal swelling, low-grade fever, and diarrhea or constipation also occur.
A burst appendix produces an abdominal mass with pain, and a temperature higher than 102° F.
Because symptoms can be much like those of other medical conditions, diagnosis can be challenging. The health care provider makes a diagnosis by using a medical history, symptoms, and physical examination. Blood tests may be done. Imaging studies including ultrasound (using sound waves to view abdominal organs) and computed tomography (CT scan) may help evaluate for appendicitis and other abdominal diseases.
Treatment is removal of the appendix, the operation is called an appendectomy. The laparoscopic type of operation is preferred. A small cut is made and the appendix is removed by using a lighted tube (scope). Another operation (open appendectomy) involves making a cut in the lower right side of the abdomen. After surgery, children are first given fluids intravenously (into a vein) but then can drink clear fluids and finally eat solid foods. Antibiotics for infection and drugs for pain, and maybe stool softeners, are usually prescribed.
Most simple cases need an overnight hospital stay. A burst appendix may mean a longer hospital stay. Most children need rest at home for 1 week before returning to school, and 2 to 3 weeks before returning to gym and sports.
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