An acute inflammation of the appendix, a narrow, worm-shaped structure positioned near the junction of the small and large intestines in the right-lower corner (called a quadrant) of the abdomen. Appendicitis is the most common reason for abdominal surgery in children.
The first symptom is usually cramping pain in the mid-upper abdomen that gradually moves downward and to the right while becoming more constant as inflammation intensifies. Loss of appetite, nausea, and vomiting commonly occur as well. Appendicitis has several different pain patterns, especially in children. Sometimes younger children do not pay attention to (or are tillable to describe) the shift in location of pain from one area to the other, especially when they are not feeding well. Older children may be more cooperative and better able to describe the location and characteristics of the pain.
Fever may develop as infection and inflammation of the appendix become more severe. If the appendix is not censored, it will likely rupture. The infection contained within it can then spread into the abdominal cavity, resulting in inflammation of the inner lining of the abdomen – a condition called peritonitis. When this occurs, pain worsens and the child becomes increasingly ill.
In children with appendicitis, the time from the first symptom (typically, cramping pain and/or nausea) to rupture of the appendix is usually less than 36 hours. Because the symptoms of appendicitis are much more difficult to identify in children younger than two years of age, the likelihood of rupture in this age-group is almost 100 percent. The frequency of rupture is much lower among older children because they can usually communicate their symptoms more clearly, allowing for an earlier diagnosis.
No single test can establish or exclude appendicitis100 percent of the time. The diagnosis is made by evaluating the child’s history, a physical examination, laboratory results, and usually some form of imaging (X-ray and/or ultrasound). A blood count, urinalysis, and possibly other laboratory studies will be ordered. Standard X-rays of the abdomen may be taken, primarily to help rule out other conditions. Over the past few years, ultra-sound has been very useful in diagnosing appendicitis. If your child’s doctor or an emergency-room physician suspects appendicitis, a surgeon will be consulted. (In some areas, family physicians perform appendectomies, in which case a surgeon would not be called.) If the surgeon agrees with the diagnosis, surgery is per-formed as soon as possible in an attempt to remove the appendix before it ruptures. This can prevent a much more severe illness, prolonged antibiotic treatment in the hospital, and longer postoperative recovery.
If the doctor feels that the appendix has already ruptured, the operation might be delayed for a number of hours to al-low for the administration of antibiotics and intra-venous fluids. If the surgeon is not sure of the diagnosis, he or she may observe the child for a period of time. Sometimes surgery for suspected appendicitis reveals a normal appendix. This is not evidence of bad medical judgment, because other conditions can mimic the pain of appendicitis. One common example is a condition called mesenteric adenitis, in which lymph nodes inside the abdomen (especially near the appendix) become enlarged, inflamed, and painful, in a manner similar to an inflamed appendix. Even if a normal appendix is found, it will be removed for two reasons (1) the appendix has no proven function of importance to human health; (2) if it is left in the patient, it can become infected at some time in the future.