Acute Appendicitis: Symptoms, Causes, and Treatment
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
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.
