Key points to remember
- the appendix is a small finger-like tube attached to the first part of the large intestine
- appendicitis is an inflammation of the appendix
- appendicitis is a potentially serious condition
- children (especially those under 5 years old) with appendicitis can deteriorate quickly
- go first to your family doctor or after-hours medical centre if your child has symptoms suggestive of appendicitis – if you cannot get an immediate appointment, go to your hospital’s accident and emergency department
What is it?
Appendicitis is when the appendix becomes inflamed and swollen. The appendix is a small finger-like tube that is attached to the first part of the large intestine (called the caecum). It is located in the lower right side of the abdomen.
What causes it?
Appendicitis is when the appendix becomes inflamed, often because of a blockage within it. The blockage causes the appendix to swell and it can easily become infected by bacteria. In many children the exact cause is not obvious, even at operation.
What puts my child at risk of getting it?
Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30. There is good evidence that the risk of appendicitis is increased when there is not enough fibre in the diet.
What are the signs and symptoms?
Symptoms can vary widely among children.
The most common early symptom is continuous tummy pain around the belly button (navel) which may move to the lower right side of the tummy (abdomen) and become sharper and more severe. It often hurts the child to move around, and the pain is worse with coughing or walking.
Your child may also have:
- a low fever
- loss of appetite
- nausea (feeling sick)
- constipation or diarrhoea
How is it diagnosed?
A diagnosis of appendicitis can usually be made by a doctor after examining your child.
Occasionally, your child may need to be examined several times.
In some circumstances, other investigations may be required, and include:
- an x-ray
- an ultrasound scan
- CT scan
- blood tests
- a urine sample (to rule out a urinary tract infection)
... but usually the diagnosis can be made by examination alone.
Appendicitis can sometimes be difficult to diagnose, especially in younger children.
When should I seek help?
Appendicitis is a potentially serious condition.
You should first go to your family doctor or after-hours medical centre if your child has symptoms suggestive of appendicitis. If you cannot get an immediate appointment, go to your hospital's accident and emergency department.
Do not give your child anything to eat or drink until they have been examined by the doctor, in case surgery is required.
You may give paracetamol to help reduce the pain. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.
What are the complications?
If the inflamed appendix is not removed, it can sometimes burst. If this happens, the infected contents of the appendix spill into the abdominal cavity. This is a more serious medical emergency. If left untreated, infection of the lining of the abdominal cavity (peritonitis) can be life-threatening and requires immediate emergency treatment, including an intravenous line and antibiotics.
The signs of a perforated appendix include a severe worsening of symptoms (especially the severity of abdominal pain) and collapse.
What treatment is required for appendicitis?
The treatment for appendicitis is an operation to remove the appendix – an appendicectomy.
The 2 techniques used are:
- open appendicectomy - a single cut (incision) is made over the appendix
- laparoscopic appendicectomy (‘key hole’ surgery) – 3 small ‘key hole’ cuts are made over the lower abdomen and special instruments are inserted through these to remove the appendix
Your child’s surgical team will discuss your child’s operation with you, including which technique they will use. You can ask them any questions you have then.
Sometimes a laparoscopic appendicectomy may need to become an open appendicectomy where the appendix cannot be safely removed any other way.
Sometimes, a child who has an operation for appendicitis ends up having another cause found for their pain. This is dealt with at the same operation.
Sometimes, when the symptoms have been going on for many days and the disease is considered advanced or complex, no surgery may be indicated initially.
What happens to my child before the operation?
- your child will not be allowed to eat or drink anything
- your child will need to have an intravenous drip (cannula or IV) put into their hand or arm before the operation (see Drips (intravenous fliuds or IV))
- occasionally a nasogastric tube may be used – a tube through the nose to the stomach – particularly if the appendicitis has been going on for a long time or there has been a lot of vomiting.
- your child’s surgeon will explain the operation, and any other treatment needed; you should feel free to ask the surgeon any questions you have
- your child will receive antibiotics at the time of surgery
- you will need to sign a consent form before the surgery takes place
What happens to my child after the operation?
- your child is watched closely immediately after the operation and as often as necessary
- the wound will be checked from time to time
- your child will receive pain relief from the nurses on the ward – older children may be able to control their own pain relief (see Patient controlled analgesia (PCA))
- your child may be given further antibiotics through an intravenous drip for several days after the surgery if the appendix was ruptured or there was peritonitis (see Drips (intravenous fluids or IV))
- your child’s hospital stay will usually be between 1 and 4 days but may be longer if the appendix was ruptured or there was peritonitis
Can there be any complications of the operation?
All surgery carries some degree of risk. One of the most common complications following appendicectomy is infection. Around 20 percent of people who have a ruptured appendix develop an abscess (collection of pus) within the abdominal cavity 2 weeks or so after the appendicectomy. If an abscess does develop, your child will need another operation to drain it. Often this can be done under special x-ray guidance.