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What
is appendicitis?
Appendicitis results from
inflammation of the appendix. (The appendix is an outpouching
from the right side of the large intestine.) This often
occurs because the appendix has become obstructed, or blocked.
However, no one really knows why this blockage happens in the
appendices of some children and not in others--so it probably
cannot be prevented.
Appendicitis is the most
common cause of emergency abdominal surgery in children in the
United States. It's somewhat more common in boys than in
girls, and more common in teenagers than in younger children.
However, appendicitis is seen in children of all ages--even (very
rarely!) newborn babies.
Signs
and symptoms of appendicitis
The most common presentation
of appendicitis usually begins with vague pain in the middle of
the abdomen. The child then begins to vomit, and loses his
or her appetite. The pain then moves to the lower right
side of the abdomen. The child may develop a low-grade fever,
and not want to walk. The child may notice that the pain
gets worse during the bumpy parts of a car ride to the doctor.
When the doctor asks the child to cough, or presses the lower
right side of the child's abdomen, the pain will also get worse.
However...
despite the fact that pediatric surgeons generally see many cases
of appendicitis, it can often be difficult to diagnose.
This is because the
signs and symptoms of appendicitis can vary greatly from child
to child. Also, many other conditions can mimic appendicitis,
including such common problems as gastroenteritis ("the flu"),
urinary tract infections, and ovarian cysts in girls. Parents
often wonder why doctors can't simply take an Xray (or an ultrasound,
or a CT scan) or a blood test for appendicitis. Unfortunately,
there are no radiologic examinations (Xrays, ultrasounds, CT scans)
or blood tests that allow us to be 100% certain that any particular
child has appendicitis (or doesn't have it).
So
how is appendicitis diagnosed? The
best "test" for appendicitis is probably a history and a physical
examination performed by an experienced physician. Blood
tests and radiologic examinations (such as ultrasounds or CT scans)
are sometimes helpful when the examiner needs more information.
A period of observation may aid in clarifying the diagnosis or
in preparing the child for surgery, although in some cases of
suspected appendicitis pediatric surgeons prefer to operate immediately.
An inflamed appendix may go on to perforate if it's not removed,
and that can prolong a child's illness significantly. It
is often safer for a child to have a suspicious appendix removed,
even if it turns out not to be inflamed, than to delay and risk
a perforation.
How
is appendicitis treated? In
the majority of cases, acute appendicitis is treated by operation
(appendectomy). Depending on the age, symptoms, and condition
of the child, this may be performed by open surgery or laparoscopically.
Antibiotics can help reduce the chance of postoperative infection,
but by themselves they cannot treat acute appendicitis.
What
should parents expect after appendectomy? Many
children with simple acute appendicitis are ready to go home in
just a few days--sometimes even the day after surgery. Children
with more advanced appendicitis, such as those with a gangrenous
or perforated appendix, usually take longer to recover.
Such children may need intravenous antibiotics or special care
for their incisions in the hospital. Children with
gangrenous or perforated appendicitis have an increased chance
of developing infections postoperatively, such as an abscess inside
the abdomen or in the surgical incision; occasionally, treatment
of these infections requires a second procedure.
What
does the appendix do?
No definite function for the appendix has been identified.
Children who have had their appendices removed grow and develop
without them in a perfectly normal way.
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