What is appendicitis?
Appendicitis is a painful swelling and infection of the appendix. The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Scientists are not sure what the appendix does, if anything, but removing it does not appear to affect a person’s health. The cause of appendicitis is not clearly understood, but it usually affects children and young adults. Appendicitis is quite rare in children under two years of age.
Children with appendicitis usually experience one or more classic symptoms, including abdominal pain, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, low-grade fever, and abdominal swelling.
A doctor or other health care provider can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. If a person shows classic symptoms, a doctor may suggest surgery right away to remove the appendix before it ruptures (bursts). Doctors may use laboratory tests and imaging studies (such as ultrasound or CAT scan) to confirm appendicitis if the diagnosis is unclear.
Typically, appendicitis is treated by removing the appendix by performing an operation called an appendectomy. If appendicitis is suspected, a doctor will often suggest surgery without conducting extensive diagnostic testing. Prompt surgery decreases the likelihood of a ruptured appendix, which can cause worsening infection in the abdomen, such as an abscess.
A minimally invasive approach to abdominal surgery, called laparoscopy is generally the first choice of surgery for appendicitis. To perform laparoscopic surgery, the surgeon inserts a rigid tube (called a trochar) into the abdominal cavity through a small incision (cut). The tube allows the surgeon to place a small camera into the abdomen and observe the structures within on an external monitor. The abdomen is inflated with carbon dioxide gas, which creates room to view the contents of the abdomen and to perform the operation. Additional rigid tubes are placed through small incisions and used to insert small surgical instruments into the abdomen. These instruments are used together with the camera to perform the operation. Tubes and instruments are removed when the operation is finished and the incisions are closed with sutures (stitches) that are absorbed by the body over time.
Laparoscopic appendectomy generally involves the use of three trochars, and therefore usually requires three small incisions. If the surgeon decides that a laparoscopic operation is not the best way to treat the problems that are found in the operating room, then the operation will be changed (converted) to use an older surgical technique. Conversion to a non-laparoscopic operation (also called an “open procedure”) is rare and requires a larger incision, which may take longer to heal.
Nonsurgical treatment may be used if surgery is not available, if a person is not well enough to undergo surgery, or if the diagnosis is unclear. Some research suggests that appendicitis can get better without surgery. Nonsurgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides.
With adequate care, most people recover from appendicitis and do not need to make changes to diet, exercise, or lifestyle. Full recovery from surgery takes about 4 to 6 weeks. In some cases, patients may continue to receive antibiotics after being discharged from the hospital. Limiting physical activity during this time allows tissues to heal.
Hospital stay following an appendectomy is typically one to three days and the decision to discharge a patient is typically based on how well the child is recovering: specifically, if the patient is able to eat regular food, has pain that can be controlled by medications taken by mouth, and has no fever or other signs of continuing infection.
Following all operations, parents or caregivers will be provided with a list of instructions, including specific warning signs that require communication with the surgical team or the attention of a doctor (either in an Emergency Department or a pediatrician’s office). Parents and other caregivers should refer first to written discharge instructions and use the telephone numbers provided to reach the Pediatric Surgery team to discuss any problems. These instructions are provided for specific patients after considering their medical conditions, the operation performed and how well the patient is recovering. Therefore, the instructions received at the time of discharge (or afterward over the phone or in the Pediatric Surgery clinic) are the best resource for parents and caregivers if questions arise. In general, the following findings should cause concern and require a patient to be seen by a doctor:
- Fever greater than 101.3F by oral or rectal thermometer
- Spreading redness, drainage (leaking fluid) from the surgical wounds that looks like pus.
- Increased bloody drainage from wound. Small amounts of yellow, pink, or blood-streaked drainage that is absorbed by the wound’s dressing is normal, and should go away in three to five days.
- Increasing pain that does not improve with medications prescribed at discharge.
- Nausea and vomiting that prevents the child from drinking clear fluids – this can be associated with certain kinds of pain medication or antibiotics and may improve if these medications are taken with food.
- The patient cannot move his or her bowels. Some medications cause constipation, so the surgical team may prescribe stool softeners or mild laxatives to help with bowel movements. If these treatments are ineffective, there may be a more serious problem.
Appendicitis is treated in the division of Pediatric General Surgery.