Appendicitis and appendectomy

Introduction

The appendix is a small tube made of muscle that is attached to the large intestine. It is usually found on the lower right side of the abdomen.

The appendix can get infected or blocked, which causes inflammation. Inflammation of the appendix is called appendicitis. 

Appendicitis is a medical emergency because there is a risk of:

• peritonitis – life-threatening infection in the abdomen
• abscess – a pocket of infected pus that collects inside the body
• sepsis – a life-threatening condition where the immune system damages its organs in response to an infection. 

Children with appendicitis may have symptoms like:

• pain that starts near the belly button and then moves to the right side of the body – uncommon in children under five years old
• fever
• vomiting.

See your local doctor as soon as possible or present to the nearest emergency department if your child shows these symptoms.

Appendicitis can be difficult to diagnose in young children.

The doctor can diagnose appendicitis by physically examining your child and checking their symptoms. 

They may also:

• do an ultrasound to see inside the body
• do a blood test
• monitor your child in the hospital for a period of time.

In most cases, appendicitis is treated by removing the appendix with surgery. This procedure is called an appendectomy. 

Antibiotics are given during and after the surgery to lower the risk of infection.

The appendix is not a vital organ, so it can safely be removed.

The appendectomy procedure will be explained to you by your child’s treatment team.

Before the procedure, your child will need to stop eating and drinking. This is called fasting or nil by mouth. 

Your child will also need antibiotics to treat infection and fluids. These are given through a small plastic tube in their vein, called an intravenous cannula.  

Some children may also need a nasogastric tube if they are vomiting a lot. This tube goes through the nose and down into the stomach.

Rarely, children may also need a urinary catheter. This is a plastic tube inserted into the bladder to drain urine.

Speak to your child’s doctor if you have any questions or concerns about the appendectomy.

Your child will be under a general anaesthetic for the surgery. This means they will be asleep and will not feel anything during the surgery.

An appendectomy can be done as:

• open surgery – where a cut is made through the skin and abdominal wall above the appendix.
• laparoscopic or keyhole surgery – where three small cuts are made in the abdomen.

In the appendectomy:

1. the blood vessels that connect to the appendix are clamped together to stop the blood supply
2. the appendix is separated from the large intestine and removed.

After surgery, your child will go to the recovery unit to wake up before moving to the ward.

Nurses will check regularly to make sure that:

• your child is recovering well
• any pain is managed
• there are no signs of infection around the surgery wound.

The doctor will let you know when your child can start eating and drinking again.

Your child may be able to go home in 6-24 hours after surgery if they are recovering well. They may need to stay longer if complications or other health issues are being treated.

Call your local doctor as soon as possible if your child shows any of the following signs once they are home from the hospital:

• redness and a hot feeling around the incision
• blood or fluid coming from the incision
• the incision starts to pull apart
• vomiting more than once
• diarrhea or watery poo that lasts longer than 24 hours
• constipation – hard, difficult poos or your child is unable to do a poo
• fever
• pain that gets worse.