Appendicitis in Children: Symptoms, and Treatment

The appendix is ​​a small portion of the intestine, about the size of a finger, that does not appear to have any essential bodily function. However, appendicitis is a medical emergency that requires surgical intervention. Appendicitis is rare in children younger than 1 year but becomes more common as children get older, and its frequency is higher in adolescents and adults by the third decade of life.

Appendicitis seems to develop when the appendix becomes obstructed, either by hardened fecal matter (so-called fecalomas) or by swollen intestinal lymph nodes, as occurs in various infections. In either case, the appendix becomes inflamed and bacteria grow inside it. Ingestion of foreign objects and infections due to certain parasitic worms (such as strongyloidiasis ) can also cause appendicitis, although it is very rare.

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Complications of appendicitis in children

If appendicitis is not detected or treated, the appendix can perforate and create a focus of infection outside the intestine ( abscess ) or leak intestinal contents into the abdominal cavity, causing a serious infection ( peritonitis ). The likelihood of the appendix rupturing depends on the age of the child. Rupture of the appendix occurs in approximately 65% ​​of children under 5 years of age and even in up to 90% of children under 2 years of age.

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Symptoms of appendicitis in children

In children older than 2 to 3 years, the order in which symptoms appear is more important than any symptoms themselves. The first symptom to appear is pain. Appendicitis almost always causes pain. The pain begins in the middle of the abdomen around the navel and then moves to the lower right abdominal quadrant. However, pain, especially in infants and young children, is more diffuse than localized to the lower right quadrant of the abdomen. Younger children may be less able to pinpoint the location of pain and maybe very irritable or agitated.

Once the pain has started, many children become nauseous or vomit and do not want to eat. The abdomen hurts when the doctor feels it, usually in the area above the appendix. A mild fever (100 to 101 ° F [37.7 to 38.3 ° C]) then appears as a common symptom. Finally, the fever is followed by laboratory test results that show infection, such as an elevated white blood cell (leukocyte) count. This order of symptoms is different from that seen in children with viral gastroenteritis, in which vomiting typically occurs earlier and pain and diarrhea occur later. The presence of significant diarrhea is not common in children with appendicitis.

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Diagnosis

  • Ultrasound
  • Sometimes other imaging tests
  • Sometimes laparoscopy

The diagnosis of appendicitis in children is complex and difficult for many reasons. Many disorders cause similar symptoms, including Meckel’s diverticulum, viral gastroenteritis, intussusception, and Crohn’s disease. Often, children, especially the youngest, do not have the characteristic symptoms or the findings of the clinical examination, especially when the appendix is ​​not in its usual position in the lower right part of the abdomen. This lack of characteristic symptoms can be misleading.

Very often the doctor does an ultrasound, which does not expose the child to radiation. If the diagnosis is unclear, the doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI). When the doctor suspects appendicitis, he usually prescribes intravenous fluids and antibiotics while waiting for the results of the blood, urine, and X-ray tests.

If the diagnosis is unclear, the doctor may perform a laparoscopy, in which a small viewing device is passed through the wall of the abdomen to visualize the interior. If appendicitis is found during laparoscopy, the doctor can remove the appendix with the laparoscope itself. Alternatively, especially in children whose symptoms and findings are not characteristic of appendicitis, physicians may simply perform repeated physical examinations. The worsening or not of symptoms and tenderness over time helps the doctor decide if it is appendicitis. Doctors also write down the order in which symptoms occur.

Forecast

With early treatment, the overall prognosis for children with appendicitis is very good. Less than 0.1% (one in a thousand) of children die. About 3% of children develop complications even if their appendix has not ruptured.

If the child does not receive treatment until the appendix ruptures, which occurs most often in children under 2 years of age, the prognosis is worse. About 10-15% of children who have surgery for a ruptured appendix have complications.

If left untreated, appendicitis can rarely go away on its own. What’s more, untreated appendicitis often progresses, leading to peritonitis, an abdominal abscess, and sometimes death.

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Treatment of appendicitis in children

The best approach for appendicitis is the surgical removal of the inflamed appendix (appendectomy).

Before surgery, doctors give antibiotics through a vein, which lowers the risk of complications. Doctors have recently discovered that appendicitis can sometimes be successfully treated with antibiotics alone. If antibiotic treatment is unsuccessful, surgical intervention is performed. Even if antibiotic therapy is thriving, children sometimes develop appendicitis repeatedly. Surgical removal of the appendix remains the recommended treatment for appendicitis.

Appendectomy is a fairly simple and safe surgery; Children without complications, such as a ruptured appendix, require a hospital stay of just 2-3 days. If the appendix has been perforated, the doctor removes it and flushes the abdomen with fluid, administers antibiotics for several days, and watches for possible complications, such as infection and intestinal obstruction. Children who have a ruptured appendix often need to stay in the hospital for a longer time.

In a percentage that is around 10% of cases, surgeons find a normal appendix while doing an appendectomy. This result is not considered a medical error, as delaying surgery when appendicitis seems likely to have serious consequences. When a normal appendix is ​​found, the surgeon looks within the abdomen for another cause of the pain. The doctor usually removes a normal appendix to eliminate the subsequent possibility of appendicitis.

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