Acute Appendicitis
The appendix is a tubular structure attached to the cecum just below the point where the small intestine opens in the large intestine
Appendix does not participate in the digestive function of the intestines. It is very rich in lymphoid tissue and is prone to inflammation/infection. Appendicitis refers to an infection or inflammation of the child's appendix. The most common cause of severe abdominal discomfort in children is appendicitis.
What causes this problem, and how common is it?
Appendicitis means inflammation/infection of the appendix in a child. There are mainly two ways in which an appendix gets inflamed.
- During non-specific viral infections, the lymphoid tissue in the appendix wall can become inflamed (catarrhal appendicitis), typically a milder form that may resolve on its own.
- Sometimes, a blocked appendix, often due to a fecal pellet, can lead to obstructive appendicitis, a serious condition that may result in perforation, abscess formation, or peritoneal cavity infection.
- When a child complains of right lower abdominal pain, acute appendicitis is typically suspected.
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What are the symptoms?
The onset is very typical in children. Loss of appetite occurs just before the pain begins in children, followed by pain in the
some other unusual features, such as diarrhoea if the appendix is located behind the intestines or difficulty straightening the right leg if the back muscles become inflamed.
How it is diagnosed?
Clinical history and examination of a child is the most important means of diagnosis supported by few blood tests. USG of the abdomen is also commonly used. Rarely a CECT abdomen is needed in the child.
What are the treatments available?
- Surgery is the primary treatment for appendicitis, typically indicated by symptoms such as anorexia, right iliac fossa pain, tenderness, and elevated white blood cell count.
- Medical treatment, including antibiotics and painkillers, may suffice for minor occurrences or catarrhal appendicitis, especially when symptoms are typical.
- Caution is advised in small children due to the risk of perforation and serious consequences if the inflamed appendix is not properly sealed off by the underdeveloped omentum.
When it should be operated?
In most cases, the appendicectomy is done in an emergency. In medically managed cases, often interval
appendicectomy after 6-12 weeks is recommended.
Are there other alternative methods of treatment?
Medical management is sometimes successful in this condition, with its inherent risks.
What does the operation involve?
There are two methods to do appendicectomy
Both have their proponents and opponents. An open appendicectomy may be preferred in cases
where complications have already occurred, e.g. an abscess formation or perforation leading to generalised peritonitis. In such situations, the tissues may be adherent, inflamed and fragile, and the surgeon may be more confident in handling
them during an open procedure. It may also be quicker. All other cases can be managed by laparoscopy
What are the possible complications / what might happen after the operation?
For the majority of children, if surgery is done by trained Paediatric surgeons, complications are rare. Reported complications include wound infection, abscess, delayed subacute obstruction etc.
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What will be the prognosis after surgery?
After surgery, children typically do not experience long-term issues. In rare cases, repeat operations may be necessary, such as in instances of generalized peritonitis where the initial procedure may involve draining pus and fluids before performing an appendectomy later. Similarly, abscesses may initially be treated with drainage, with an appendectomy deferred to a later procedure.
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