Appendicitis

The appendix is a tubular structure attached to the cecum just below the point where the small intestine opens in the large intestine

It does not participate in the digestive function of the intestines. It is very rich in lymphoid tissue and is prone to inflammation/infection. Appendicitis refers to an infection or inflammation of the child's appendix. The most common cause of severe abdominal discomfort in children is appendicitis.

What causes this problem, and how common is it?

Appendicitis means inflammation/infection of the appendix in a child. There are mainly two ways in which an appendix gets inflamed.

During non-specific viral infections, the lymphoid tissue in the wall of the appendix gets reactively inflamed (catarrhal appendicitis). This is usually the milder form and may settle down on its own.
Sometimes, the appendix gets blocked by a faecal pellet to give rise to obstructive appendicitis. This is more serious and can perforate and give rise to abscess formation or generalised infection of the peritoneal cavity.
This is how frequently it occurs: whenever a child complains of pain in the right lower abdomen, acute appendicitis is always suspected.

What are the symptoms?

The onset is very typical in children. Loss of appetite occurs just before the pain begins in children, followed by pain in the right lower abdomen, vomiting, fever, and possibly some other unusual features, such as diarrhoea if the appendix is located behind the intestines or difficulty straightening the right leg if the back muscles become inflamed.

When to consult your doctor?

Parents should visit a Pediatrician if their child exhibits any of the above-mentioned symptoms.

How it is diagnosed?

Clinical history and examination of a child is the most important means of diagnosis supported by few blood tests. USG of the abdomen is also commonly used. Rarely a CECT abdomen is needed in the child.

What are the treatments available?

Surgery is the most common modality available to treat this condition. A combination of anorexia, right iliac fossa pain and tenderness with elevated white blood cell count is enough evidence to suggest surgical treatment. USG results may support the diagnosis.
Sometimes, especially in situations of catarrhal appendicitis or when the symptoms are typical, medical treatment, such as antibiotics and painkillers, can treat minor occurrences.
However, it is used with caution in small children as the omentum is not well developed to seal off an inflamed appendix, and perforation can lead to serious consequences.

When it should be operated?

In most cases, the appendicectomy is done in an emergency. In medically managed cases, often interval appendicectomy after 6-12 weeks is recommended.

Are there other alternative methods of treatment?

Medical management is sometimes successful in this condition, with its inherent risks.

What does the operation involve?

There are two methods to do appendicectomy

The open method
Laparoscopy.

Both have their proponents and opponents. An open appendicectomy may be preferred in cases where complications have already occurred, e.g. an abscess formation or perforation leading to generalised peritonitis. In such situations, the tissues may be adherent, inflamed and fragile, and the surgeon may be more confident in handling them during an open procedure. It may also be quicker. All other cases can be managed by laparoscopy

What are the possible complications / what might happen after the operation?

For majority of children, if surgery is done by trained Paediatric surgeons, complications are rare. Reported complications include wound infection, abscess, delayed subacute obstruction etc.

What will be the prognosis after surgery?

After surgery, child do not experience any long-term issues. Rare circumstances can call for a repeat operation; for instance, if the child had generalized peritonitis and their condition was poor, an initial procedure might just involve draining the pus and other fluids, with an appendicectomy coming later. Similarly, an abscess may initially be treated by drainage and the appendicectomy may be deferred to a later procedure.

Frequently Asked Questions

1. What is appendicitis?

The appendix, a small pouch-like organ situated in the lower right belly, becomes inflamed, and this condition is known as appendicitis. If not treated right once, it can become uncomfortable and even cause significant consequences.

2. What causes appendicitis?

Appendicitis is often caused by the blockage of the appendix's opening, leading to bacterial growth, infection, and inflammation. The blockage can result from stool, foreign objects, or an enlarged lymph node.

3. What are the common symptoms of appendicitis?

Common symptoms include abdominal pain starting near the belly button and shifting to the lower right side, loss of appetite, nausea, vomiting, fever, and pain during movement.

4. How is appendicitis diagnosed?

Diagnosis involves a physical examination, reviewing medical history, and often imaging tests such as ultrasound or CT scan to visualize the inflamed appendix.

5. Is surgery always necessary for appendicitis?

In most cases, surgical removal of the inflamed appendix (appendectomy) is the standard treatment to prevent rupture and complications. Laparoscopic or open surgery may be used.

6. What happens if appendicitis is left untreated?

An infected appendix might rupture if neglected, causing infection to spread throughout the abdomen (peritonitis) and leading to potentially life-threatening complications.

7. Can appendicitis occur in children?

Yes, appendicitis can affect people of all ages, including children. However, symptoms in children might differ, and early diagnosis is crucial.

8. How soon should appendicitis be treated?

Appendicitis requires immediate medical attention. If symptoms of abdominal pain, fever, and vomiting develop, it's important to seek medical care promptly.

9. Can appendicitis be prevented?

While it's not always preventable, maintaining a healthy diet, regular exercise, and avoiding constipation might reduce the risk of developing appendicitis.

10. Are there complications associated with appendicitis surgery?

Appendectomy is generally a safe procedure. However, as with any surgery, there can be risks of infection, bleeding, or complications related to anesthesia. Most individuals recover well with proper postoperative care.

11. Are there other conditions with similar symptoms to appendicitis?

Yes, conditions like ovarian cysts, urinary tract infections, and gastroenteritis can cause abdominal pain and mimic appendicitis symptoms. Proper diagnosis is important to rule out other causes.

12. Can appendicitis recur after surgery?

Once the appendix is removed, the likelihood of recurrent appendicitis is extremely low. The risk of future appendicitis is eliminated by the surgery.