Appendicitis

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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What is the appendix?

The appendix is a coiled, 8- 12 cm tube attached to the caecum (the first part of the large intestine or bowel). It is usually located in the lower right side of the abdomen.

What is appendicitis?

Appendicitis is inflammation of the appendix. This can be caused by an infection or a blockage in the appendix. With a blockage, the appendix can become swollen and easily infected by bacteria. The swelling and infection can cause the appendix to rupture (burst). This results in peritonitis (infection inside the abdomen) or the formation of an abscess around the appendix.

What are the most common signs and symptoms of appendicitis?

  • Pain that starts near the belly button, then moves to the right side (this feature may not be present in children aged under 5 years).
  • Fever. 
  • Vomiting.

How can the doctor be sure it’s appendicitis?

The diagnosis of appendicitis can usually be made by examining your child and discussing their symptoms. Blood tests, an ultrasound or other investigations may be done if the diagnosis is less certain. A period of observation in hospital is often more useful than tests. The diagnosis can be more difficult in younger children. Sometimes, the diagnosis isn’t suspected until the appendix has ruptured. In a small number of cases, the diagnosis is suspected but the symptoms prove to have another cause.

Treatment of appendicitis

The best treatment is to remove the appendix, although this is being reviewed in ongoing studies. The operation may be done through a single incision over the appendix or by laparoscopy (‘key hole’ surgery). Antibiotics are given at the time of the operation to reduce the chance of infection.

About 1 in 5 children who have an operation for appendicitis turn out to have another cause for their pain. The decision to do an operation has to balance the risk of surgery, against the risk of ongoing untreated appendicitis. The surgical team will discuss these factors with you when deciding whether to operate.

What happens to my child before going to the operating theatre?

  • Your child must not eat or drink (‘nil by mouth’) to have an empty stomach before the operation. The doctors and nurses will talk to you about the timings for this.
  • Your child should try to empty their bladder (pass urine) before the procedure. If your child is not able to pass urine please tell the surgical team before the operation. In this case a catheter may be needed to empty the bladder in theatre.
  • Your child will be monitored, measuring temperature, respirations, pulse and any changes in behaviour or level of pain
  • The surgeon will explain the operation to you.
  • Your child may be given fluids in a drip (intravenous).
  • A nasogastric tube (a tube through the nose to the stomach to keep the stomach empty and prevent vomiting) may be used. 
  • Your child will be given pain medicine.
  • Any other treatment needed before the operation will be explained by the doctors and nurses looking after your child. You should feel free to ask questions at any time.

What happens after the operation?

  • Your child is monitored hourly for four hours, then as often as is necessary depending on their condition.
  • Your child’s wound is checked regularly.
  • Some pain is expected after the operation, but medicines are given to relieve pain and will be explained to you. Antibiotics will be continued in the drip if the appendix was ruptured or there was pus identified in the abdominal cavity.
  • The doctors will talk to you about when your child can start eating and drinking. Usually drinks, followed by food can be started the next day. This may be delayed if the appendix was ruptured or your child is nauseous or vomiting. Meanwhile, fluid is given through a drip to avoid dehydration.
  • The Hospital stay is usually 2-4 days, but may be longer if the appendix was ruptured.
  • There can be complications secondary to appendicitis including infection within the abdomen which may require additional antibiotics and/or procedures.

Prevention

There are no medically proven ways to prevent appendicitis.

Remember:

  • Children with appendicitis can deteriorate quickly.
  • If you suspect appendicitis, go to your family doctor or local hospital without delay.
  • Feel free to ask any questions of the doctors and nurses caring for your child. 
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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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