Appendicitis

What is it?

The appendix is a small tube-shaped organ that is attached to the first part of the large intestine and is most commonly located in the right lower quadrant of the abdomen. In some cases, the appendix can become obstructed by fecal material, undigested food, inflamed lymph nodes or other foreign material. When this happens, inflammation of the appendix results, and infection sets in. This is referred to as appendicitis. 

What are the most common symptoms?

Your child may complain of abrupt, sharp localized pain that comes and goes. The pain may start around the belly button, and then migrate to the right lower abdomen. Pain may be worse with movement, specifically when walking or shifting positions. Other common signs and symptoms include loss of appetite, fever, nausea and vomiting.

How is it treated?

Once the diagnosis of appendicitis has been confirmed — usually by ultrasound or CT — initial management includes fluid replacement via intravenous fluids, intravenous antibiotics and pain medications. The next step is an appendectomy, which is a surgical operation to remove the infected appendix. Appendectomy is the standard surgical treatment for appendicitis.  

What happens in surgery?

Typically, patients undergo what we call a laparoscopic appendectomy. Laparoscopic means the surgeon performs minimally invasive surgery using a thin tube with a camera, called a laparoscope, attached to it. This scope is inserted through a small incision made in your child’s skin, typically in the belly button. The surgeon may also make two more small incisions for other surgical instruments. In some cases, the surgeon may need to extend the incisions to allow for better visualization into the abdomen and exposure of the appendix. While the camera is inside the abdomen, it projects images on a video monitor, allowing the surgeon to better visualize the interior of your child’s abdomen. The appendix is carefully divided from the large intestine and removed from inside the abdomen. The incisions are then closed with dissolvable sutures and covered with skin glue and/or small bandages. 

Will my child have to stay in the hospital?

In the case of simple (non-ruptured) appendicitis, most patients are discharged from the hospital and can go home the same day their surgery is performed. Prior to discharge, you will be given instructions regarding diet, activity restrictions, bathing, dressing/wound care, medications, follow-up and when to return to school. In cases of advanced (complicated) appendicitis (gangrenous, perforated, etc.), your child may need to stay in the hospital following surgery for up to seven days for pain control and intravenous antibiotics to prevent further infection in the abdomen.