Understanding Appendicitis in Children

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What is appendicitis and who is affected?

Acute appendicitis stands as the most frequent reason for emergency surgical intervention in children. The appendix, a small extension of the large intestine, becomes inflamed, leading to this condition. While it predominantly affects children aged 10 to 14, it can be more severe in younger children due to delayed diagnosis. Appendicitis is observed more frequently in boys than in girls.

What function does the appendix serve?

Once considered a non-functional organ, the appendix was routinely removed during surgeries for other conditions. However, modern research has identified its role in the immune system, owing to the lymphoid tissue present in its walls. Occasionally, swelling of this tissue mimics appendicitis symptoms but does not require surgery unless true appendicitis develops. Surgical removal of the appendix, if necessary, is not believed to cause significant long-term effects on a child’s health.

How does appendicitis develop?

The appendix can become obstructed, preventing mucus discharge. This blockage, often due to fecal stones or food remnants like seeds, leads to fluid build-up, appendix swelling, and impaired blood circulation, resulting in inflammation. Infections in other body parts, like the throat or lungs, can also trigger lymphoid tissue swelling, causing blockage. Initially, the infection is contained within the appendix (acute appendicitis), but without timely treatment, the appendix may burst (perforated appendicitis), spreading infection throughout the abdomen, potentially leading to life-threatening conditions such as septic shock.

What are the symptoms?

The hallmark symptom of appendicitis is abdominal pain, which begins as a mild discomfort near the navel and intensifies over 24 hours, shifting to the lower right abdomen. While older children can articulate their symptoms, young children may struggle to describe their pain, often leading to delayed diagnosis and increased risk of perforated appendicitis. Additional symptoms in children include:

• Loss of appetite – a crucial early sign
• Nausea and vomiting – typically following the onset of pain
• Diarrhea
• Fever – more prevalent in cases of perforated appendicitis
• Walking with a right-sided lean
• Lying still with knees drawn up

As the infection progresses, children may become lethargic and weak, with persistent fever, vomiting, and diarrhea.

How is the diagnosis made?

Diagnosing appendicitis begins with a thorough history, exploring the onset and nature of the pain, appetite changes, and additional symptoms. A physical examination by a pediatric surgeon is crucial and can often confirm the diagnosis, warranting an operation. Blood tests provide further insight into the child’s condition, and ultrasonography (USG) aids in the diagnosis. Advanced imaging like computed tomography is seldom needed unless other conditions are suspected.

What other conditions can mimic appendicitis?

In children, appendicitis may be confused with other conditions exhibiting similar symptoms, such as:

• Gastroenteritis
• Constipation
• Urinary tract infections
• Ovarian cysts in girls
• Inflammatory bowel diseases
• Intestinal intussusception (knotting)

How is appendicitis treated?

The primary treatment for appendicitis is an appendectomy, the surgical removal of the appendix. For non-perforated appendicitis, patients are usually discharged on the same day. In cases of perforation, hospital stays extend to 3-7 days for intravenous antibiotic treatment. Full recovery typically spans 1 to 2 weeks post-hospitalization.

What are the risks of avoiding surgery?

If left untreated, appendicitis can lead to perforation, spreading infection throughout the abdominal cavity, resulting in peritonitis and potentially life-threatening systemic infections like septic shock. Prompt surgical intervention is crucial to avoid such complications.