Appendicitis is one of the most common surgical diseases in the United States. It typically affects school-age children, but can affect younger children as well.

The onset of the disease is usually marked by abdominal pain, which may begin around the umbilicus, but always settles in the right side of the abdomen. Vomiting and loss of appetite may be associated also. Diarrhea may occur if the disease has been going on for a few days. Fevers may be present later in the course of the illness. Appendicitis is a progressive disease. It will become progressively worse with time.

The appendix is part of the intestines, but a part that has no function in humans. It is about the size of your index finger, and it is a blind sac. Apparently, the opening to the appendix becomes blocked, and this sets up first an irritation, then an infection. The appendix starts to swell with pus increasing the symptoms of right lower abdominal pain. With time, the pus starts leaking out of the appendix into the abdomen.  This is called perforated appendicitis. Now the symptoms of abdominal pain may become generalized and fever and diarrhea may ensue.

Diagnosing appendicitis is not always easy. First, many of the early symptoms may be confused with a viral gastroenteritis (flu). Secondly, there is no specific test for diagnosing appendicitis. The history of the onset and progression of the symptoms, and the examination of the patient and lab tests (such as a blood count and urine test) are taken together in the assessment. Sometimes radiology studies such as a CT scan (CAT scan) are also used. Sometimes watching the patient in the hospital will provide the diagnosis since appendicitis is a progressive disease. 

Once the diagnosis is probable appendicitis, the patient is prepared for an operation under general anesthesia to remove the appendix. This is usually performed laparoscopically. A small incision is made at the belly button and two smaller ones in the left lower portion of the abdomen. This allows us to easily see and remove the appendix and to wash out any pus that may have leaked out of the appendix. The operation takes around an hour. If the appendix is not perforated, the child may go home in 1-3 days. If the appendix is perforated, the patient will remain in the hospital longer on intravenous antibiotics. Occasionally, recurrent pus needs to be drained.

Sometimes the child is first diagnosed with appendicitis after the pus or abscess around the appendix is consolidated or walled-off in one area. Then the pus may be drained, the patient placed on antibiotics and the appendix removed several weeks later after the irritation from the appendicitis is resolved. This is called an interval appendectomy.

Not all abdominal pain is appendicitis. However, if the pain is persistent, or does not seem like the typical symptoms your child has with the flu, a visit to the doctor is in order.

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