Parents often mistake appendicitis for a bad stomachache. It can be particularly difficult to diagnose in younger children, who can’t adequately describe their pain. CHOC pediatric surgeon Dr. Troy Reyna, who says appendicitis is the most common reason for abdominal surgery in children, provides helpful insight for parents in the following Q & A.
The appendix is a small extension of the intestine usually the size and length of one’s little finger. The appendix finds its home in the right lower corner of the abdomen. It is attached to the cecum, which is the beginning of the large intestine.
It is thought that appendicitis starts as a result of obstruction either by swelling of the inner lining (mucosa) or by hard stool (fecalith). Once the obstruction starts, the appendix swells, resulting in pain that may start centrally and later migrate to the lower right abdomen. Anyone with an appendix can get appendicitis. Approximately 80,000 children in the United States suffer from it each year.
The pain with appendicitis may be vague in the beginning and be confused with the stomach flu. Generally, though, the flu will subside after 24 hours of slight bowel rest. In appendicitis, the pain will increase in intensity and often cause a child to become immobile, as movement can aggravate the pain. The location of the pain is usually midway between the navel and the right hip bone. Pain that persists and is associated with other symptoms, such as vomiting, decreased appetite, decreased frequency of stools or changes in mental status, requires prompt attention by a medical professional.
If your child is seen in a doctor’s office and his exam is mild, you will likely be advised on fluid management and told to followup in 24 hours if no improvement is noted. If your child is seen in a pediatric emergency facility, such as the Julia and George Argyros Emergency Department at CHOC Hospital, he will likely receive an IV (intravenous) to get needed fluids, and get blood drawn for a lab study. He may also receive an abdominal ultrasound. If a diagnosis of appendicitis is considered, then a pediatric surgeon will be called to assess your child and address any questions or concerns you may have.
The operation for appendicitis is usually done with laparoscopy. One to three small incisions are made in the belly button and off to the side. Small plastic tubes are placed through the incisions. A camera is placed into the abdomen to visualize the appendix or look for the cause of the pain. The appendix is usually then stapled or tied off and removed. The small incisions are closed. If the appendix was not ruptured, your child can drink and eat as soon as it is safe and go home within 24 hours of surgery. If the appendix is ruptured, your child will need extra antibiotics for several days to treat the peritonitis and prevent further infection.
The appendix is carefully inspected during the surgery. In about 15 to 20 percent of the time, the appendix is normal and another cause is discovered that will require surgery. The cause may be an anomaly of the gastrointestinal tract. In girls, the problem could also be related to the fallopian tubes or ovaries. Whatever the cause, it will be treated. After surgery, the pediatric surgeon will brief you thoroughly on details and expectations.
After your child is discharged from the hospital, there will be a short recuperation at home – approximately two to three days. He will be restricted from physical education for two to three weeks. He’ll need to be seen, for follow up, by his surgeon about two weeks after leaving the hospital. Within six weeks, your child should be able to resume normal activity.
Dr. Troy Reyna is a pediatric surgeon with CHOC Specialists. He is board-certified in general and pediatric surgery. He can be reached at 714-364-4050.