What is the appendix?
The appendix is a small coiled 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. The appendix becomes swollen and infected by bacteria. Complicated appendicitis is when the swelling and infection causes the appendix to rupture (burst). This results in peritonitis (infection inside the abdomen) or an abscess around the appendix. In early appendicitis this rarely happens and rupture does not occur in every case. There are no medically proven ways to prevent appendicitis from happening.
What are the most common signs and symptoms of appendicitis?
- Pain that starts near the belly button, then moves to the right side (this is often not present in children aged under 5 years).
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. 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 symptoms prove to have another cause.
Treatment of appendicitis
The best treatment is to remove the appendix, although in some situations appendicitis can be treated with antibiotics. Your doctor can discuss this with you. The operation is 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 10 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’) so that they have an empty stomach before the operation. The doctors and nurses will talk to you about this.
- Your child should try to pass urine before the procedure. If your child is not able to pass urine please tell the surgical team before the operation.
- Your child will be monitored, measuring temperature, respirations, pulse, changes in behavior and pain.
- Your child may be given fluids and antibiotics through a drip (intravenous).
- A nasogastric tube (a tube through the nose to the stomach to keep the stomach empty) may be used if your child is unwell and vomiting a lot.
- 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. The timing of the operation will depend on your child’s condition and will be discussed with you.
What happens after the operation?
Your child’s surgical team will let you know after surgery if your child’s appendicitis was uncomplicated or complicated based on your child’s condition.
The plan for the care of your child with uncomplicated (simple) appendicitis will include:
- Monitoring temperature, respirations, pulse, changes in behavior and pain.
- Walk around once the nurse or doctor says it is safe.
- Eat and drink once the nurse or doctor says it is safe.
- Have oral medicine for pain relief. If you stay overnight your child will be woken early in the morning to take paracetamol so that they will be more comfortable. Some pain is expected after surgery. To help with this your child has had some pain relief and local anesthetic during surgery. Over the first 24-48hrs some children experience pain in the shoulders from the gas used in keyhole surgery. This kind of pain is relieved by alternating rest with walking and cold or warm packs.
- Have an intravenous cannula that will be removed before discharge
- Walk to the bathroom to pass urine
- Have abdominal dressings which will be checked by a nurse or doctor
- Not require further antibiotics
- Usually be discharged between 6-24hrs after surgery depending on your child’s condition
If your child has complicated appendicitis their hospital stay will range from 2 days to 10 days. The plan for the care of your child with a more complicated appendicitis will include:
- Frequent monitoring until your child improves and then less frequently until discharge from hospital.
- Have an intravenous cannula with a drip and antibiotics.
- Eat or drink when the doctor or nurse says it is safe to do so. If your child has an extended time of not being able to eat and drink they may need to be fed intravenously through a special line that is inserted in theatre.
- Walk around once the physiotherapist, doctor or nurse says it is safe to do so.
- Pain relief as discussed with you by the anaesthetist.
- Have abdominal dressings which will be checked by a nurse or doctor.
- Can need assistance with their hygiene needs – please ask a nurse to help you.
- May have a nasogastric tube in their nose to drain the stomach contents to prevent vomiting.
- May have a urinary catheter into the bladder to drain urine.
- Can have complications that may require further tests and procedures. This will be explained to you if these occur.
You will receive a discharge information sheet with instructions on how to care for your child at home.
If you will need a Medical Certificate, let your nurse and doctor know as soon as possible.