The appendix is a small hollow organ attached to the large intestine located in the right lower part of the abdomen. Like the tonsils and adenoids, it contains a large number of lymph glands. If the appendix becomes inflamed, a condition called appendicitis results and the organ will have to be removed with an appendectomy. The appendix is not necessary for health and can be taken out at an early age without adverse effects.
The most common signs and symptoms of appendicitis are abdominal pain, tenderness, vomiting and fever. The pain may be around the navel (belly button) but soon moves to the lower right portion of the abdomen. The most painful area is located halfway between the hip bone and the navel, but may vary. The child may be bent over with the pain and may prefer lying down on the left side with the knees drawn up to the chest. Vomiting, and refusal to eat may be other signs of appendicitis. Diarrhea may be present.
When the child is brought to the hospital the doctor will do a complete physical exam on the child looking for specific tender areas of the abdomen. Blood for lab tests will be drawn to check for signs of inflammation or infection. Your child’s white blood count may be high if appendicitis is present. Your child will not be allowed to eat or drink while the diagnosis is being made. This is to prepare for surgery should it be necessary. Your child may have IV fluids started to make sure he/she has enough fluid intake to prevent dehydration. In some cases, other x-rays may be taken including an ultrasound or CAT scan. A pediatric surgeon will examine your child if the doctor thinks he/she may have appendicitis.
If the appendix has not broken open, an appendectomy will be done to remove the inflamed appendix. This operation is either done through a small incision in the lower abdomen or using laparoscopic surgery. Laparoscopic surgery involves 3 small incisions in the abdomen large enough to insert a telescope-like device that finds the appendix and removes it. The recovery from surgery is usually fast and the child is often home in 1-2 days. The child will be started on clear liquids and advanced to a regular diet as he/she tolerates it. Sitting in a chair and walking are very important. This may be difficult at first. Pain medication is available to relieve the pain. Please feel free to ask your nursing staff or the pediatric surgery team any questions that you may have.
If the appendix is ruptured, a larger abdominal incision may be required to remove the appendix. Peritonitis (inflammation of the abdominal cavity caused by the release of stool into the abdomen) may occur and will be treated with antibiotics for up to 10 days following surgery. Your child may come out of surgery with an NG (nasogastric tube) to empty the stomach of acids that are normally produced by the body to digest food. Your child will be able to start on clear liquids and progress to a normal diet after the NG tube output is low, the child has bowel sounds (gurgling sounds that signal the digestive tract is working) and the child passes gas or stool. It is very important to breathe deeply, walk and sit in a chair as much as possible. If you need assistance, please ask your nurse or any member of the pediatric surgery team.
Sometimes if the child has been sick for days, an abscess may have formed inside the abdomen. This may be drained by X-ray guidance and the child will be treated with antibiotics until the infection has resolved. In most patients this treatment is successful and the appendix is then removed 6 to 8 weeks later.
Your child can return to school within a few days of leaving the hospital but may not be able to participate in sports or physical education for one or two months.
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