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 normally in the lower right side of the abdomen.
The appendix may become inflamed because of a blockage within it. The blockage causes the appendix to swell, and it can easily become infected by bacteria. Often, the cause is not clear.
Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30. There is some evidence that the risk of appendicitis increases when there is not enough fibre in the diet.
Symptoms vary in different tamariki. The most common early symptom is continuous tummy pain around the belly button (navel). The pain may move to the lower right side of the tummy (abdomen) and become sharper and more severe. It often hurts more when your child moves around, and the pain worsens when coughing or walking.
Your child may also have:
A doctor can usually make a diagnosis of appendicitis after talking to you about your child's symptoms and by examining your child. Occasionally, a doctor may need to examine your child several times over several hours or even repeatedly over a day or two. Appendicitis can sometimes be difficult to diagnose, especially in younger tamariki.
In some circumstances, your child may need other tests, such as:
See the KidsHealth section on x-rays and scans to learn more about different scans [1]
Go first to your family doctor or after-hours medical centre if your child has symptoms you think may be due to appendicitis. If you cannot get an appointment straight away, go to your hospital's accident and emergency department.
Appendicitis can be a serious condition.
Do not give your child anything to eat or drink until the doctor has examined your child. This is in case surgery is needed.
You may give your child paracetamol to help reduce the pain. Follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.
If an inflamed appendix isn't removed by the surgeon, 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, it can lead to an infection of the lining of the abdominal cavity (peritonitis), which can be life-threatening. This requires emergency treatment, including an intravenous line (IV) and antibiotics.
The signs of a perforated appendix include:
Usually, an operation called an appendicectomy is done to remove the appendix.
In some specific situations, surgery may be put off while your child is treated with antibiotics.
There are 2 ways this surgery can be done - an open appendicectomy and a laparoscopic appendicectomy.
Open appendicectomy
A surgeon makes a single cut (incision) over where the appendix is. The inflamed appendix is removed through this cut.
Laparoscopic appendicectomy ('keyhole' surgery)
A surgeon will make 3 small 'keyhole' cuts over the lower abdomen. Then, they insert special instruments through these cuts to remove the appendix.
When a laparoscopic appendicectomy becomes an open appendicectomy
Sometimes, a laparoscopic appendicectomy may need to become an open appendicectomy if the surgeon cannot safely remove the appendix any other way.
Your child will have the surgery under general anaesthetic (GA) - they will be completely asleep.
See the KidsHealth page on anaesthetic to learn more about what a GA involves [2]
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.
Occasionally, a surgeon will find another cause for the pain during the appendicectomy. If this happens, the surgeon will deal with it during the same operation.
All children having an appendicectomy will get at least one dose of antibiotics during the surgery.
Sometimes, if your child's symptoms have been going on for many days or if it is an advanced or complex case, doctors will give strong antibiotics through an intravenous (IV) drip. If this happens, your child's doctor may delay the surgery deliberately.
See the KidsHealth page on drips to learn more about IV drips [3]
In some cases, your child may need a nasogastric tube - a tube through the nose to the stomach. Your child is more likely to need this if their appendicitis has been going on for a long time or they have vomited a lot.
See the KidsHealth section on pain management to learn more about different types of pain relief [4]
All surgery comes with some potential risks. One of the most common complications following appendicectomy is infection. Around 20% of people with a burst appendix develop an abscess (collection of pus) inside their tummy. This usually shows up within 2 weeks after the appendicectomy.
If an abscess does develop, your child may need another operation to drain it. Often, doctors can use a special x-ray to help guide them as they insert a narrow tube to drain the pus. Your child won't need a full operation if doctors use this technique.
Illustration by Dr Greta File. Property of KidsHealth.
This page last reviewed 11 September 2023.
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Links
[1] https://www.kidshealth.org.nz/tags/x-rays-scans
[2] https://www.kidshealth.org.nz/anaesthetic
[3] https://www.kidshealth.org.nz/drips-intravenous-fluids-or-iv
[4] https://www.kidshealth.org.nz/tags/pain-management
[5] https://www.kidshealth.org.nz/contact?from=http%3A%2F%2Fwww.kidshealth.org.nz%2Fprint%2F180%3Flanguage%3Drar