Appendicitis

Key points to remember about appendicitis

• the appendix is a small finger-like tube attached to the first part of the large intestine
• appendicitis is an inflammation of the appendix
• appendicitis is a potentially serious condition
• children (especially those under 5 years old) with appendicitis can deteriorate quickly
• go to your family doctor or after-hours medical centre first if you think your child has symptoms of appendicitis - if you cannot get an appointment straightaway, go to your hospital's accident and emergency department

What is appendicitis?

Appendicitis is when the appendix becomes inflamed and swollen. The appendix is a small finger-like tube that is attached to the first part of the large intestine (called the caecum). It is normally in the lower right side of the abdomen.

What causes appendicitis?

The appendix may become inflamed because of a blockage within it. The blockage causes the appendix to swell, and it can easily become infected by bacteria. In many children, the exact cause is not obvious, even during the operation.

What puts my child at risk of getting appendicitis?

Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30. There is some evidence that the risk of appendicitis increases when there is not enough fibre in the diet.

What are the signs and symptoms of appendicitis?

Symptoms can vary widely among children. The most common early symptom is continuous tummy pain around the belly button (navel) which may move to the lower right side of the tummy (abdomen) and become sharper and more severe. It often hurts the child to move around, and the pain is worse with coughing or walking.

Your child may also have:

• a low fever
• loss of appetite
• nausea (feeling sick)
• vomiting
• constipation or diarrhoea

How is appendicitis diagnosed?

A doctor can usually make a diagnosis of appendicitis after examining your child. Occasionally, a doctor may need to examine your child several times over several hours or even repeatedly over a day or two.

In some circumstances, your child may need other investigations such as:

• an x-ray
• an ultrasound scan
• blood tests
• a urine sample (to rule out a urinary tract infection)

Appendicitis can sometimes be difficult to diagnose, especially in younger children.

When should I seek help for appendicitis?

Go first to your family doctor or after-hours medical centre if your child has appendicitis symptoms.

Appendicitis is a potentially serious condition. You should first go to your family doctor or after-hours medical centre if you think your child may have appendicitis. If you cannot get an appointment straightaway, go to your hospital's accident and emergency department.

Do not give your child anything to eat or drink until the doctor examines them. This in case your child needs surgery.

You may give your child paracetamol to help reduce the pain. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

What are the complications of appendicitis?

If doctors don't remove an inflamed appendix, it can sometimes burst. If this happens, the infected contents of the appendix spill into the abdominal cavity. This is a more serious medical emergency. If left untreated, infection of the lining of the abdominal cavity (peritonitis) can be life-threatening. This requires immediate emergency treatment, including an intravenous line and antibiotics.

The signs of a perforated appendix include:

• a severe worsening of symptoms - especially severe abdominal pain and swelling
• reluctance to move because it makes the pain worse

What is the treatment for appendicitis?

The treatment for appendicitis is an operation to remove the appendix - an appendicectomy.

The 2 techniques used are:

• open appendicectomy- a surgeon makes a single cut (incision) over where the appendix is
• laparoscopic appendicectomy ('key hole' surgery) - a surgeon will make 3 small 'key hole' cuts over the lower abdomen - they will then insert special instruments through these cuts to remove the appendix

Your child's surgical team will discuss your child's operation with you, including which technique they will use. You can ask them any questions you have then.

Sometimes a laparoscopic appendicectomy may need to become an open appendicectomy if the surgeon cannot safely remove the appendix any other way.

Occasionally, a surgeon will find another cause for the pain during the appendicectomy. If this happens, the surgeon will deal with it during the same operation.

Sometimes, if the symptoms have been going on for many days or if it is an advanced or complex case, doctors will give strong antibiotics through an intravenous drip. If this happens, your child's doctor will delay the surgery deliberately.

What happens to my child before the operation to remove their appendix?

• your child will not be allowed to eat or drink anything
• your child will need to have an intravenous drip put into their hand or arm before the operation
• your child's surgeon will explain the operation, and any other treatment needed - you should feel free to ask the surgeon any questions you have
• your child will receive antibiotics at the time of surgery
• you will need to sign a consent form before the surgery 

In some cases, your child may need a nasogastric tube - a tube through the nose to the stomach. Your child is more likely to need this if their appendicitis has been going on for a long time or they have vomited a lot. 

What happens to my child after the operation to remove their appendix?

• the healthcare team will watch your child closely immediately after the operation and as often as necessary
• they will check the wound from time to time
• the nurses on the ward will give your child pain relief - older children may be able to control their own pain relief (see Patient controlled analgesia (PCA))
• your child may have antibiotics through an intravenous drip for several days after the surgery if the appendix ruptured or there was peritonitis
• your child's hospital stay will usually be between 1 and 4 days but may be longer if the appendix ruptured or there was peritonitis

Can there be any complications from the operation to remove my child's appendix?

All surgery carries some degree of risk. One of the most common complications following appendicectomy is infection. Around 20 in 100 people who have a ruptured appendix develop an abscess (collection of pus) within their abdominal cavity 2 weeks or so after the appendicectomy.

If an abscess does develop, your child will need another operation to drain it. Often doctors can use a special x-ray to help guide them as they insert a narrow tube to drain out the pus. Your child won't need a full operation if doctors use this technique.