Appendicitis in children: symptoms, diagnosis, and treatment

1- What is appendicitis?

Appendicitis is an inflammation of the appendix, a small, tube-shaped organ located at the junction between the small intestine and the colon. If the appendix becomes blocked (by stool, infections, or swollen lymph nodes), it can swell and become infected. Without treatment, the appendix can rupture, leading to a serious infection in the abdominal cavity called peritonitis.

Appendicitis can affect children of all ages but is most common in children over five years old and adolescents.

2- Symptoms of appendicitis in children

The symptoms of appendicitis may vary, but the most common signs include:

a. Abdominal pain

• The pain often begins near the belly button and then moves to the lower right side of the abdomen.

• It becomes more intense over time and is often described as “sharp” or “stabbing.”

• The pain worsens with movement, coughing, or walking.

b. Loss of appetite

• A sudden loss of appetite is often one of the first signs.

• The child may refuse to eat or feel nauseous.

c. Nausea and vomiting

• Nausea and vomiting typically appear shortly after the abdominal pain begins.

• Unlike other gastrointestinal issues, vomiting does not relieve the pain.

d. Fever

• A mild fever between 38°C and 38.5°C (100.4°F to 101.3°F) may occur.

• If the appendix ruptures, the fever may increase.

e. Changes in bowel movements

• The child may experience mild diarrhea or constipation.

• Trapped gas and bloating are also possible.

f. Tenderness to touch

• The lower right side of the abdomen becomes extremely sensitive.

• Pressing gently on the area and releasing may worsen the pain (rebound tenderness), a classic indicator of appendicitis.

3- When to be concerned?

Certain symptoms require immediate medical attention:

• Severe abdominal pain lasting for more than a few hours.

• High fever.

• Persistent vomiting.

• Apathy or lethargy.

• Abdominal pain accompanied by bloating or an inability to pass gas.

If these symptoms appear, consult a doctor immediately. Untreated appendicitis can lead to a ruptured appendix and peritonitis, a potentially life-threatening condition.

4- Diagnosing appendicitis in children

Diagnosing appendicitis can be challenging in young children because the symptoms may resemble those of other conditions, such as gastroenteritis or a urinary tract infection. Several methods help confirm the diagnosis:

a. Physical examination

• The doctor checks for tenderness in the abdomen and assesses the pain’s location.

• They may look for rebound tenderness and other signs of abdominal sensitivity.

b. Blood tests

• Blood tests can detect signs of infection, such as an elevated white blood cell count.

c. Imaging tests

• An abdominal ultrasound is often used to visualize the appendix and confirm inflammation.

• In some cases, a CT scan may be required to make a definitive diagnosis.

5- Treatment of appendicitis

The standard treatment for appendicitis is an appendectomy, a surgical procedure to remove the appendix. This surgery is usually performed as an emergency to prevent rupture and peritonitis.

a. Appendectomy

• Open surgery: A single incision is made in the lower abdomen to remove the appendix.

• Laparoscopic surgery: This minimally invasive approach involves small incisions through which a camera and surgical instruments are inserted to remove the appendix.

Laparoscopic surgery is often preferred because it causes less post-operative pain and allows for faster recovery.

b. Antibiotics

• Antibiotics are administered before and after surgery to treat or prevent infection.

• If the appendix has ruptured, a longer course of antibiotics may be required to treat peritonitis.

6- Recovery after appendectomy

Recovery after appendectomy is usually quick for children. Here are some steps to ensure smooth recovery:

• Rest: The child should rest for a few days after surgery.

• Hydration and diet: Gradually reintroduce food, starting with soft foods.

• Follow-up care: A post-operative follow-up ensures that there are no complications, such as wound infections.

• Return to activities: Most children can resume school or regular activities within one to two weeks after surgery.

7- How to prevent appendicitis?

There is no specific way to prevent appendicitis, but a diet rich in fiber (fruits, vegetables, whole grains) can help prevent constipation, which may reduce the risk of developing appendicitis.

Conclusion

Appendicitis is a common surgical emergency in children, and recognizing the early signs can prevent serious complications. If your child experiences persistent abdominal pain, especially in the lower right side, along with fever or vomiting, it is important to seek medical care promptly. The Centre Pédiatrique de Bonapriso is here to provide expert care and ensure your child receives timely treatment for a safe recovery.