Appendicitis
Appendicitis is inflammation and infection of the appendix.
The appendix is a small finger-length portion of intestine that does not appear to have any essential bodily function (see Section 9, Chapter 118). Appendicitis is a medical emergency that requires surgery. Appendicitis is rare in children younger than 1 year but becomes more common as children grow older and is most common in adolescents.
Appendicitis seems to develop when the appendix becomes blocked either as a result of infection in the digestive tract or elsewhere in the body or, less commonly, as a result of obstruction with hard feces. In either case, the appendix becomes infected. If an infected appendix is unrecognized or untreated, the appendix can rupture, creating a pocket of infection outside the intestine (abscess) or spilling contents of the intestines into the abdomen (peritonitis).
Symptoms and Diagnosis
Appendicitis almost always causes pain. The pain may start in the middle of the abdomen, near the navel, and gradually move to the lower right area of the abdomen. However, children younger than 2 years are often not able to complain of pain and are therefore more likely to be irritable or listless. They may lose consciousness partly or completely if a delay in diagnosis has led to rupture of the appendix with peritonitis. Older children sometimes develop diffuse abdominal pain rather than pain in the specific area of the appendix.
The diagnosis of appendicitis in children can be challenging for many reasons. The child can have gastroenteritis, Meckel's diverticulum, intussusception, or Crohn's disease, all of which may cause symptoms similar to those of appendicitis. The child may not have a fever or elevated white blood cell count, which are signs of infection. And the child may ask for food rather than avoid it in the way adults with appendicitis typically do.
Doctors who suspect appendicitis usually give intravenous fluids and antibiotics while waiting for results of blood tests. They may order ultrasound or computed tomography (CT) scans to see inside the abdomen. Repeated physical examinations help a doctor determine whether the condition is improving or getting worse and make a decision about treatment.
Treatment
The best treatment for appendicitis is surgical removal of the inflamed appendix (appendectomy). Appendectomy is fairly simple and safe, requiring a hospital stay of 2 to 3 days. If the appendix has ruptured, the doctor removes it and may wash out the abdomen with fluid, give antibiotics for several days, and watch for complications, such as infection and bowel blockage. About 10 to 20% of the time, surgeons discover a normal appendix while performing an appendectomy. This is not considered a medical error because the consequences of delaying surgery when appendicitis is suspected are serious. When the appendix is found to be normal, the surgeon looks within the abdomen for another cause of the pain. The doctor may remove the normal appendix so that the child will never develop appendicitis.
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