The appendix is a narrow, finger-shaped, hollow
structure attached to the large intestine. While
it serves no purpose in humans, it can cause
serious problems when it becomes inflamed. Because
of its location, this can happen quite easily. For
example, a piece of food or stool can get trapped
inside, causing the appendix to swell, become
infected and painfully inflamed. This
inflammation, called appendicitis, is most common
in youngsters over the age of six, but can occur
in younger children as well. Once infected, the
appendix must be removed. Otherwise it may burst,
allowing the infection to spread within the
abdomen.
Because this problem is potentially
life-threatening, it's important to know the
symptoms of appendicitis so you can call your
pediatrician at the first sign of trouble. In
order of appearance, the symptoms are:
- Abdominal Pain: This usually is the
child's first complaint. Almost always, the
pain is felt first around the umbilicus (belly
button). After several hours as the infection
worsens, the pain may intensify in the lower
right side. Sometimes, if the appendix is not
located in the usual position, the discomfort
may occur elsewhere in the abdomen or in the
back, or there may be urinary symptoms such as
increased frequency or burning. Even when the
appendix lies in its normal position and the
pain is in the right lower abdomen, it also
may irritate one of the muscles that leads
toward the leg, causing the child to limp or
walk bent over.
- Vomiting: After several hours of
pain, vomiting may occur. It is important to
remember that stomachache comes before the
vomiting with appendicitis, not after.
Abdominal pain that follows vomiting is
commonly seen in viral illnesses such as the
flu.
- Loss of appetite: The absence of
hunger occurs shortly after the onset of the
pain.
- Fever: There may be a low-grade fever
(100-101 degrees Fahrenheit; 38-38.5 degrees
Celsius).
Unfortunately, the symptoms associated with
appendicitis sometimes may be hidden by preceding
viral or bacterial infections. Diarrhea, nausea,
vomiting, and fever may appear before the typical
pain of appendicitis, making the diagnosis much
more difficult. Also, your child's discomfort may
suddenly vanish, thus persuading you that all is
well. Unfortunately, this disappearance of pain
also could mean that the appendix has just broken
open. Although the pain may leave for several
hours, this is exactly when appendicitis becomes
dangerous. The infection will spread to the rest
of the abdomen, causing your child to become much
more ill, develop a higher fever, and require
hospitalization for surgery and intravenous
antibiotics. Recovery may take much longer, and
there may be more complications than with
appendicitis diagnosed and treated earlier.
Detecting the signs of appendicitis is not
always easy. This is particularly the case in a
child under the age of three, who cannot tell you
where it hurts or that the pain is moving to the
right side. Therefore, it's better to act sooner
rather than later if you have any suspicion that
your child's pain or discomfort seems
"different," more severe than usual, or
out of the ordinary. While most children with
abdominal pain don't have appendicitis, only a
physician should diagnose this serious problem.
If the abdominal pain persists for more than an
hour or two, and if your child also has nausea,
vomiting, loss of appetite, and fever, notify your
pediatrician immediately. If the doctor is not
certain the problem is appendicitis, she may
decide to observe your child closely for several
hours, either in or out of the hospital. During
this time, she will have performed additional
laboratory or X-ray examinations to see if more
conclusive signs develop. If there is a strong
probability that appendicitis is present, surgery
usually will be done as soon as possible.
In almost all cases, the treatment of
appendicitis is surgical removal of the appendix.
In rare instances, the tissue covering the
intestines may enclose the appendix, thus
containing the infection. This makes it more
difficult to remove the appendix without spreading
the infection, so antibiotics may be used, either
alone or combined with drainage of the infection
by a small tube. Because inflammation can recur
even after the initial infection is gone, the
appendix usually is removed later on.
