What is appendicitis?

Infection/inflammation of the appendix is called as appendicitis. It can be acute, sub-acute or chronic/recurrent appendicitis.

Appendix is a small tubular extension of the intestine attached to the large intestine near the junction of large and small intestine in the right side of lower abdomen.

What are the symptoms of acute appendicitis?

Pain around the middle of the belly near the belly button. The child may have decreased appetite and feels like vomiting. The pain never completely goes away and becomes sharper with time. After a few hours, pain moves to the right lower side of the belly. Sometimes, a child complains of right lower abdominal pain while walking, or refuses to stand up or walk due to pain. Most children with appendicitis have a fever of 38°-39° C (100.5° - 102°F). There may be episodes of diarrhea.

Younger children (younger than five years old) have a higher chance of having ruptured appendicitis because they may not be able to talk clearly about their symptoms. If the appendix ruptures, a high fever may be seen.

What are the tests to confirm the diagnosis of appendicitis?

Thorough history taking and clinical examination by the treating doctor is important for the diagnosis of appendicitis. The doctor may ask for blood and urine examination, sonography of abdomen and/or X-ray of abdomen. Sometimes, the doctor may ask for a CT scan of abdomen.

What are the complications of untreated appendicitis?

If untreated, the appendix may perforate and lead to peritonitis and septicemia which may be fatal.

What is the treatment of acute appendicitis?

The standard treatment of acute appendicitis is surgical removal of appendix. The preferred mode of surgery is laparoscopic appendectomy.

Laparoscopy offers early recovery, lesser incidence of wound infection and allows inspection of other abdominal organs.

Antibiotics are an integral part of treatment. Intravenous fluids and pain medications are also required.

What is the outcome of surgery?

The outcome is excellent. Surgical site infection, abscess formation and adhesive intestinal obstruction are rare complications.

What is ruptured (perforated) appendicitis?

Appendicitis is inflammation and infection of the appendix and often results from blockage of the appendix by stool (feces). Sometimes the feces forms a small stone called a fecalith. Other causes of appendicitis include swelling of lymph tissues within the appendix wall because of recent infection; sometimes worms can also block the appendix.

Once blockage of the appendix occurs, it cannot empty itself and pressure in the appendix increases. It is further complicated by bacterial overgrowth in the appendix. The swelling and pressure cuts off blood supply to appendix and the wall becomes weak and a hole results which is called ruptured / perforated appendicitis. It may take 36 to 48 hours between onset of appendicitis symptoms and rupture of appendix.

Rupture occurs in about one of three children with acute appendicitis. Younger the age, higher the chances of ruptured appendix. The severity of ruptured appendicitis is different for every patient. Some children have a small rupture, while others may have a big spillage of stool and pus into the abdomen. Still others can have problems with intestinal blockage from the inflammation and infection. Some children who have appendicitis going on for days before the diagnosis may be so sick that the infection spreads into the blood stream. This is a serious condition and can be life-threatening. These patients will need to be stabilized before undergoing surgery. Therefore, the treatment including timing of surgery depends on how sick the patient is.