The appendix is a narrow tube-like structure attached to the large intestine. It is present in the right side's lower part of the tummy. Appendicitis is swelling of the inner wall of the appendix.
Appendicitis
Appendicitis is caused by stool blocking the opening of the appendix. When the appendix is blocked, bacteria can grow and cause infection. An infected appendix swells and causes tummy pain. If it is not removed, an inflamed appendix can burst. This can spread infection inside the tummy and lead to serious problems. At this stage, the appendix is not known to have any specific function.
Appendicitis is most common for children between 4 and 14 years of age. It is rare, but possible, in younger children.
The standard treatment for appendicitis is to remove the appendix by an operation, called appendicectomy. In most cases, it will be done soon after the diagnosis. Some centres are trying the treatment of acute appendicitis by antibiotics alone and avoiding surgery. This method is not well established.
Symptoms
The commonest symptom of appendicitis is pain in the tummy. The pain usually starts around the umbilicus and then shifts to the right lower part of the tummy. In most cases, the pain does not get better even if the child lies still. Any movement makes it worse.
In addition to pain, the most common symptoms of appendicitis are:
• Vomiting
• Lack of appetite
• Diarrhea
• Fever
Children may have a low-grade fever in the beginning. If the appendix bursts, there can be a high fever, around 39 degrees Celsius, because of the spreading infection.
If you think your child may have appendicitis, consult your General Practitioner (GP) or Paediatrician or attend the emergency unit of a hospital as soon as possible. Do not give your child anything to eat or drink, except pain medication.
Diagnosis
A detailed history and examination looking for painful and tender areas. Often, it is difficult to differentiate appendicitis from other causes of pain in the tummy of a child. Repeated examination and the following tests may help.
Blood and urine test
• X-ray +/- Ultrasound scan of the tummy
Treatment
If doctors believe the appendix has already burst and the tummy is badly infected, strong antibiotics are given first to control the infection, and surgery is delayed.
Surgery
Appendicectomy is done under general anaesthesia through a cut in the right lower part of the tummy. It takes about an hour. Your child will be in the recovery room for another half an hour till the effect of an aesthesia wears off. We will give them pain medicine around the clock to make them comfortable. If possible, we will try to perform this operation through tiny (keyhole) cuts on the tummy, with the help of a camera inserted inside- a laparoscopic approach.
After the operation
If the appendix has not burst, your child will stay in the hospital for a couple of days after surgery.
If the appendix bursts, he/she will need to stay in the hospital for about a week. He/she will get antibiotics and fluids through an intravenous (IV) line during this time. Your child will not be able to eat or drink immediately after the surgery because the bowel takes time to recover in such cases. Your child is also more likely to get complications like wound infection, and collection of pus inside the tummy and may need another operation to clean such collection.
About two to three weeks after surgery, your child must see your GP or the surgeon for a follow-up visit. The doctor will ensure the incision is healing and your child is recovering well.
