Appendicitis

What is appendicitis?

Appendicitis is a swelling of the appendix. The appendix is a small, tube-like structure attached to the first part of the colon, called the cecum. It is in the lower right side of your child's belly. It has no known function in the body.

Signs and symptoms of appendicitis

Appendicitis may be shown by the following symptoms:

• pain around the navel or the lower right-hand side of the belly, which gets worse with light pressure on the area, deep breathing or movement
• loss of appetite
• nausea
• vomiting
• fever

If the appendix has burst, your child will feel continuous, severe pain throughout the whole abdomen.

Causes

Appendicitis happens when the appendix becomes infected. Infection can be associated with a blockage in the appendix. The blockage or infection can cause the appendix to swell, leading to pain. There is also the risk of the appendix bursting.

Risk factors

Appendicitis can affect children and adults at any age. Anyone with an appendix can develop appendicitis.

What happens when you get appendicitis?

After the appendix becomes infected and swells, your child may complain of pain, nausea or have loss of appetite. A fever may develop. Your child may vomit. The symptoms are like gastroenteritis, which makes diagnosis unclear unless you bring your child to a health-care provider to get checked out. If the infection is not treated, the appendix can burst and the infection can spread to the rest of the tummy, causing more pain, diarrhea, vomiting and fever.

How a health-care provider can help your child with appendicitis

Your child’s health-care provider will examine your child. They may order an IV for fluids, blood and urine tests, and an ultrasound or CT scan to confirm the diagnosis. Your child will then undergo surgery to take out the appendix. This operation is called an appendectomy. It is a common procedure.

If the appendix has not burst and there are no complications, your child will be discharged home the same day of the surgery or within two to six hours after surgery.

Your child can go home when:

• Their heart rate, breathing, blood pressure and temperature are normal.
• They are able to drink clear fluids.

If your child's appendix did burst, they will be prescribed more antibiotics after the surgery. They may have to stay in the hospital until the signs of infection, such as fever, have cleared up. After surgery, your child can eat a normal diet. Most children go back to their normal activities within a week or two.

What is appendectomy? Is that the only treatment for appendicitis?

If your child is healthy, appendicitis can be very safely managed with appendectomy, which provides your child with a permanent cure for appendicitis. An appendectomy (removal of the appendix) can be done through a small skin incision. If the appendix has burst and an abscess has formed, the infection will not be completely treated by appendectomy, and your child will need antibiotics to treat the abscess. The abscess may need to be drained.

Sometimes there are abscesses that need to be treated first and surgery has to be deferred until later (interval appendectomy) when the infection has resolved (usually a few months after the initial infection).

Can you prevent appendicitis?

The exact cause of appendicitis is not known. Since the cause is not known, it is not possible to prevent appendicitis. However, if your child has had appendicitis, appendectomy is the only way to prevent it from recurring.

Complications

If the swollen or infected appendix is not treated, the appendix can burst. This can lead to a severe infection inside the belly. This infection can cause the bowels to stop moving, resulting in vomiting and a distended belly. Your child may not be able to tolerate drinking or eating. They may get dehydrated from vomiting. Occasionally, the infection can result in bowel blockage.

How you can help your child with appendicitis

Ask your child to explain the pain they are experiencing. Contact your child's health-care provider or go to the emergency room if you suspect appendicitis.

What happens after appendectomy?

Appendectomy cures appendicitis. There are no long-term concerns following appendectomy. If the appendix has burst and there is infection inside the belly, your child's surgery may be postponed until antibiotics treat the abscess. Your child will have a follow-up visit to check that the infection has been fully treated before the appendectomy is considered. In this case, appendectomy is not an emergency operation; it is a planned procedure that will happen once your child is completely well again.

When you should seek medical assistance

You should take your child to a health-care provider if your child has severe abdominal pain or ongoing unexplained fever or irritability. Take your child to the closest emergency department if you suspect the appendix has already burst.

Resources

Today's Parent — Common causes of stomach pain in children and when to worry

References

Morrow, S.E., & Newman K.D. (2007). Current management of appendicitis. Seminars in pediatric surgery, 16(1), 34–40. https://doi.org/10.1053/j.sempedsurg.2006.10.005

Stewart, S., Cruz-Centeno, N., Marlor, D. R., St Peter, S. D., & Oyetunji, T. A. (2023). Bridging the Gap: Pediatric General Surgery for the Pediatrician. Pediatrics in review, 44(11), 632–643. https://doi.org/10.1542/pir.2022-005894