General and Thoracic Surgery Appendicitis Surgery
General and Thoracic Surgery Appendicitis Surgery

Appendicitis Surgery

Symptoms of Appendicitis

Appendicitis is most common in children and teens, usually between ages 8 and 20. About one in 15 people in the United States will get appendicitis during their lifetime, making it one of the most common surgical conditions. 

Appendicitis is inflammation and subsequent infection in the appendix. The initial symptoms may mimic a stomach ache. However, this medical condition can cause minimal to severe abdominal pain, depending on the degree of appendiceal inflammation.

In children younger than 2, the most common symptoms are:

  • fussiness, inconsolability
  • a distended abdomen
  • vomiting

In older children, symptoms of appendicitis are:

  • mild fever
  • significant pain in the lower abdomen, typically near the belly button (initially) that starts intermittently and then becomes constant usually on the right lower side of the abdomen
  • lack of appetite
  • nausea
  • vomiting
  • diarrhea (usually minimal)

If your child shows symptoms of appendicitis, do not give him or her any pain medications, food or drink. Contact your doctor immediately for further instructions. 

Causes of Appendicitis

You can’t prevent appendicitis from happening, and it develops when the appendix becomes obstructed. If treatment has not started when the appendix becomes inflamed, it can lead to a “ruptured” appendix. If a ruptured appendix is left untreated, your child may begin to be very ill and their abdomen will become distended and very tender. 

Diagnosis of Appendicitis

Your child’s doctor will examine your child’s abdomen looking for signs of tenderness or pain to confirm whether the diagnosis of appendicitis is present and whether treatment is necessary. Sometimes, the doctor may order urine or blood tests, which can identify the level of white blood cells, a sign of infection. Other imaging tests may also be necessary, such as X-rays, CAT scans or ultrasounds. The results of these tests can help predict the likelihood of having appendicitis and/or provide a diagnosis of appendicitis. 

Treatment of Appendicitis

The sooner you recognize the signs of appendicitis and doctors can treat it, the better. If appendicitis is not treated, it can rupture. Appendicular rupture is a condition that usually occurs about 48 to 72 hours after the first symptoms if treatment has not been initiated. Indications that your child has a perforated appendicitis may include having fevers — up to 104°F (40°C) — and pain that spreads from the right side of the abdomen across the entire abdomen.

There are different treatment options for appendicitis depending on if your surgeon thinks that your child’s appendix is ruptured. 

Acute Appendicitis:

If the appendix is felt to be inflamed and not ruptured, there are now two options to treat appendicitis. 

  • A laparoscopic appendectomy. Using this technique, the surgeon makes three small quarter-inch incisions in the abdominal wall while your child is under anesthesia. Through one, he/she inserts a laparoscope, which is a telescope that allows them to see into the abdomen and view it on a computer monitor. Through other incisions, he/she then can access, and remove the appendix.
  • Intra-venous antibiotics without surgery: Your child will be actively monitored and treated with antibiotic. If he/she is doing well, he/she will go home in a day or two. 

Ruptured appendicitis:

If the appendix is felt to be ruptured or perforated (has a hole in it), this can be handled two ways:

  • A laparoscopic appendectomy. Using this technique, the surgeon makes three small quarter-inch incisions in the abdominal wall while your child is under anesthesia. Through one, he/she inserts a laparoscope, which is a telescope that allows them to see into the abdomen and view it on a computer monitor. Through the other incisions, he/she then can access, and remove the appendix.
  • Abdominal drainage of fluid around the appendix and appendectomy at a later time. If it has been more than a few days since your child's appendix ruptured, your child might not have surgery right away. That's because the body sometimes forms a walled off abscess inside the abdomen, to block off the area that became infected when the appendix ruptured. In such cases, the surgeon may first treat your child with antibiotics and watch him or her. He or she might take the appendix out once the antibiotics have made your child feel better, or stick a needle in the walled-off abscess to drain the infected fluid. This treatment is usually done at the same time as an imaging test, so that the radiologist can see where to put the needle. After the doctor treats the infection, he or she might recommend that your child have surgery at a later date.

In preparing for all types of treatment for appendicitis, your child will be given:

  • intravenous (IV) therapy to deliver fluids and antibiotics
  • pain medication 

If your child’s appendix has ruptured, treatment will also include staying in the hospital receiving Intra-venous antibiotics until your child is free of fever, and can eat and drink without difficulty. There is also a risk of developing an infected fluid collection (abscess) around where the appendix was located, even after surgery, which may require image guided treatment. 

Appendicitis Recovery Time 

For non- perforated appendicitis, your child will be able to go home within a few hours of surgery and within a day of antibiotic therapy. If the appendix has ruptured, your child will need to stay in the hospital for about three to six days, with discharge determined by being afebrile for 24 hours and being able to eat and drink. 

There are no restrictions on how quickly your child can resume eating a normal diet, their activities or school once he/she leaves the hospital.

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