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Appendicitis


Disclaimer: This fact sheet is for educational use only. Please consult your doctor or other health professional to make sure this information is right for your child.

Key points to remember about appendicitis

  • 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 five years old) with appendicitis can deteriorate quickly
  • go first to your GP (general practitioner) 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

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What is appendicitis?

Appendicitis is an inflammation of the appendix. The appendix is a small finger-like tube that is attached to the first part of the large intestine. It is located in the lower right side of the abdomen. The appendix has no known useful function in humans.
 

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What causes appendicitis?

Appendicitis is usually caused by a blockage in part of the appendix. The blockage causes the appendix to swell and it can easily become infected by bacteria.
 

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What puts my child at risk of getting appendicitis?

Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30.
 

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What are the signs and symptoms of appendicitis?

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. 
 
Your child may also have:

  • a low fever
  • loss of appetite
  • nausea (feeling sick)
  • vomiting
  • constipation or diarrhoea

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How is appendicitis 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:
.... but usually the diagnosis can be made by examination alone.
 
Appendicitis can sometimes be difficult to diagnose, especially in younger children. 
 

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When should I seek help?

Appendicitis is a potentially serious condition.
 
You should first go to your GP (general practitioner) 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. 
 

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What are the complications of appendicitis?

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 much 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.
 
The signs of a perforated appendix include a severe worsening of symptoms and collapse.
 

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What treatment is required for appendicitis?

The treatment for appendicitis is an operation to remove the appendix – an appendicectomy.
 
The two techniques used are:
  • open appendicectomy - a single cut (incision) is made over the appendix
  • laparoscopic appendicectomy (‘key hole’ surgery) – three 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.
 

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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 (cannula 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 and is severe
  • your child’s surgeon will explain the operation, and any other treatment needed; you should feel free to ask them any questions you have

  • your child will receive antibiotics at the time of surgery


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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 PCA (patient controlled analgesia)
  • 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 (cannula or IV))
  • your child’s hospital stay will usually be between one and four days but may be longer if the appendix was ruptured or there was peritonitis

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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 two weeks or so after the appendicectomy. If an abscess does develop, your child will need another operation to drain it. Sometimes, this can be done under special x-ray guidance.
 

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Endorsement

This fact sheet was endorsed by PSNZ - 28/07/2010

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Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2010


The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
http://www.starship.org.nz