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| |    Appendicitis by Robert Needlman, M.D., F.A.A.P. reviewed by Lynn Cates, M.D., F.A.A.P. The appendix is a small part of the intestine that doesn't seem to have any particular function, except to cause trouble from time to time. The appendix is located where the small intestine joins the large intestine, which is almost always in the lower right-hand side of the abdomen. A normal appendix is a tube that is open on one end (where it joins the intestines) about the diameter of a pencil and an inch or two long. If the opening gets blocked off, bacteria lodged in the intestine can multiply, resulting in an infection. This infection is called appendicitis. What causes appendicitis? Occasionally, the opening to the appendix will become blocked by something a child eats--a seed, for example. But most of the time, there's no way to know what caused the appendicitis to start. Most children who develop appendicitis are perfectly healthy until their appendixes flare up. How does appendicitis develop? Early in appendicitis, the appendix becomes stretched out by the infection growing inside it. This usually causes a cramping pain, which the child feels in the area of the umbilicus (belly button), rather than in the actual location of the appendix itself. The pain becomes worse and worse. Eventually, the infection can break through the wall of the intestine, causing an infection in the abdominal cavity itself. At first this infection is located only near the appendix--usually, but not always, in the lower right-hand part of the abdomen. (Note: Contrary to popular opinion, the pain of a ruptured appendix is not always felt on the right. The intestines can move about within the abdomen, and sometimes the appendix can end up in the mid-line or even on the left.) If the infection spreads throughout the abdominal cavity (a condition known as peritonitis), the whole abdomen can become extremely painful. A child with this condition is seriously ill, so it's important to treat appendicitis before this happens. What are the warning signs? Anytime a child has severe abdominal pain that does not go away in an hour or two, the question of appendicitis should be raised. A child with appendicitis initially may have pain in the center of the belly, poor appetite, and a low fever. Vomiting and diarrhea may appear next. Later in the illness, he may have pain lower down in his abdomen, probably on the right side (a sign that the infection is spreading outside of the appendix). If you gently push on that area, he is likely to wince in pain. A stoical child may only admit to feeling a little bit of discomfort, but if the pain lasts for a few hours without getting better, it's wise to consider appendicitis as a possibility. A very young child, or one who has significant developmental delay, may not be able to tell you where he hurts until the appendix has already burst. In these children in particular, it can be very difficult to tell the difference between early appendicitis and a minor infection of the intestines, described below. A good rule of thumb is when in doubt, have your child seen by a doctor-you want to have your child treated before the appendix bursts. Most of the time, of course, the cause of the abdominal pain is a minor infection in the intestines, a so-called stomach bug, more formally known as gastroenteritis. These infections usually are caused by viruses; sometimes they are caused by bacteria (these tend to be more severe.) These common intestinal infections are often accompanied by vomiting, diarrhea, and fever. Most times, children with these infections do not seem extremely ill, even though they are pretty uncomfortable. A child who has an upset tummy, who isn't running a fever, or who has some vomiting and diarrhea, probably does not have appendicitis. But if you are at all concerned, it is always wise to talk with your child's doctor. There are many causes of abdominal pain in children. This is one of those areas where a parent's gut feeling (so to speak) is important. If your child seems sick to you, get medical advice. If it turns out to be simply a stomach bug or something he ate, there's no real harm done. How is appendicitis diagnosed and treated? Doctors are trained to diagnose appendicitis based on the combination of medical history and physical examination. Sometimes tests such as an ultrasound or an x-ray of the abdomen can be helpful. Often, however, the only sure way a doctor can know that the appendix is infected is to actually remove the appendix surgically. Occasionally, the surgeon will begin the operation only to find that the appendix is not infected, and that the symptoms of appendicitis are the result of another condition that might not have required an operation. This is not malpractice as long as the surgeon had good reason to suspect appendicitis. With this disease, it is better to be safe than sorry! Most children recover very well from their appendicitis operation and are left with only a tiny scar. The scar is usually located so that even a very skimpy bathing suit hides it. In the unlucky instances when the infection has had a chance to spread throughout the abdominal cavity, the child will be much sicker, the hospitalization will be longer, and there can be more long-term consequences, including decreased fertility. So, again, early treatment is wise.
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