Pediatric Appendicitis

Pediatric Appendicitis

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Summary

The appendix is a narrow tube of intestine that extends from the colon. Appendicitis means the appendix is infected and inflamed. Acute appendicitis can cause abdominal pain and is the most common childhood surgical emergency. 

Expanded Overview

Annually, 70,000 cases of pediatric appendicitis occur in the U.S. It occurs most often in children between the ages of 10 and 17.

The rates of appendicitis are higher in developed nations, correlating to diets that are low in fiber and high in sugar. Other risk factors include family history and infection.

The inflammation and infection of the appendix triggers obstructions of drainage and blood flow, so trapped bacteria multiply, distending the appendix and leading to ischemia. Without intervention, necrosis and gangrene occur; a perforated appendix could occur within 72 hours after the original obstruction.

When that happens, bacterial-laden inflammatory fluid leaks into the abdominal cavity, potentially resulting in peritonitis – a serious condition.

Symptoms

The most common symptom is abdominal pain, which may start in the area around the belly button and move to the lower right-hand side of the abdomen. Other symptoms include:

Symptoms might not show up in children. Delayed diagnosis increases the risk of rupture and its serious complications.

Treatment

Conservative approach

Not every case of perforated appendicitis needs an emergency appendectomy; in some cases, medical management of the infection allows for an appendectomy to be postponed.

In that case, patients are started on IV fluids, in place of regular diet, and receive intravenous antibiotic therapy. Patients who fail to improve on medical management will require surgical treatment fairly quickly.

Appendectomy

The pediatric surgeons at Children’s Health, typically removed the appendix using a minimally invasive method called Laparoscopic Appendectomy. 

This procedure uses three small incisions and a camera called a laparoscope to look inside the abdomen during the operation.

A child whose appendix ruptured will have to stay in the hospital longer than the child whose appendix was removed before it ruptured. Some children will need to take antibiotics by mouth for a period of time specified by the physician after they go home.

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