Welcome to Children's Surgery, an informational resource by Eric A. Nicholls, FRACS FRCS, Consultant Paediatric Surgeon

Appendicitis

Appendicitis is a common cause of significant abdominal pain in children.

Usually starting as general or central abdominal pain, it tends to become more apparent in the lower, right corner of the abdomen after 6-18 hours. There is often, associated lack of appetite with nausea and sometimes one or two vomits. The children can become dehydrated with a fast heart rate. They are often pale, but can become flushed if perforation has occurred.

Children with appendicitis often have a low grade temperature initially, but if perforation has occurred, then a high temperature will develop.

In Appendicitis, the abdomen is usually very tender to touch in the lower, right corner of the abdomen and hopping on the right leg worsens the pain significantly.

Unfortunately, perforation of the appendix is more common and occurs sooner in the younger children.

If antibiotics have been given for an alternative diagnosis, then the diagnosis of appendicitis may be delayed and an inflammatory mass may develop. An inflammatory mass would require a further 5 days of intravenous antibiotics in hospital and the appendix would need to be removed at a later date.

Many viral illnesses can cause abdominal pain and tenderness, but these will often result in a high temperature initially with other possible symptoms such as a headache or a sore throat.

In some situations, the diagnosis of appendicitis may not be immediately evident. Ultrasound and blood tests may be necessary to help with making the diagnosis and occasionally a CT scan might be performed. A period of observation in hospital can be useful in the earlier stages of the symptoms. With intravenous fluids and pain relieving medication, the symptoms associated with viral illnesses will subside.

Treatment

Appendicectomy should be performed as soon as possible after the diagnosis has been made by a specialist childrens surgeon. This may be performed laparoscopically or open if appropriate.

If perforation has occurred, then a further 5 days of intravenous antibiotics will be necessary.

It is rare for hospitalisation to extend beyond 6 days and if recovery has not occurred by this time, then it is likely that there is a complication such as further infection within the abdomen.

Depending upon the severity and length of the illness, convalescence at home may take up to a month. If appendicitis is caught early enough, then after appendicectomy, the child may be discharged from hospital after 24 hours and may be back at school within the week.