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  • Appendicitis

  • Appendicitis

    Learn more about appendicitis:

    What is appendicitis?

    The appendix is a tubular structure the size of a worm (its Latin name is appendix vermicularis, or 'worm-like attachment'), which is attached to the first portion of the large bowel (the cecum). It is hollow and communicates with the intestine. However, because of its narrow size, it may become plugged with hard stools. In part because of this, pressure and infection may build inside the appendix. This inflammation and infection is called appendicitis. It most often presents as pain to the right lower portion of the abdomen, typically at a point between the belly button and the ridge of the pelvis on the right side. Commonly, the onset of pain is followed by nausea, vomiting and fever. As the process worsens, pain becomes more intense, and the wall of the appendix may become severely infected and even necrotic (become dead tissue). This may create a hole in the wall of the appendix, through which the infection can spread outside, into the abdominal cavity: the appendix is now perforated, or ruptured. If left unchecked, ruptured appendicitis would rapidly lead to severe inflammation and infection of the entire abdominal cavity (peritonitis), and eventually of the whole body. Once sepsis (i.e., spread of the infection to the blood and to other organs) sets in, the patient becomes severely sick and is at risk of dying unless he or she receives treatment.

    Although it is very difficult to establish exactly when appendicitis starts, and how long it will take from early infection to rupture, this takes on average 24 to 72 hours. Some children may perforate early on, while occasionally it may take several days before a rupture occurs.

    Appendicitis can occur at any age. However, it is extremely rare in the first few years of life (but when it presents that early, e.g. before the age of 4, children are often very sick and the appendix is almost always already ruptured). It is also much less common in the elderly; it most commonly affects teenagers and young adults. There is no clear cause for appendicitis (except for the possible obstruction of the appendix by stool, which probably contributes to it), and it is not known why some children get it and others don't. There are no known risk factors for the development of appendicitis.

    Why does appendicitis require?

    There is not a non-operative treatment for appendicitis. If the condition is not treated, it will most certainly progress to perforation (rupture), making the child very sick. Therefore, operating early in the course of the disease offers the best chances for a simple operation and a speedy recovery. The risk of complications is much less if the appendix has not yet ruptured at the time of the operation.

    Antibiotics, to fight the infection, have some effect on the disease. They may decrease the severity of the symptoms and, in some cases, delay the onset of perforation. Unfortunately, they only mask the severity of the condition without preventing its complications.

    What needs to be done before surgery?

    In most cases, your child will be otherwise healthy, and the condition will not have been present for very long. Therefore, little needs to be done in terms of preoperative preparation or lab testing. It is always preferable that your child be without eating or drinking for at least six hours before the operation. However, since this is an emergency, it may sometimes be safer to proceed rapidly with removal of the appendix. Since appendicitis is often characterized by abdominal pain, nausea and vomiting, chances are your child will not have eaten much recently anyway.

    If your child has been sick for a while, and particularly if he has been vomiting a lot, has had high fevers and/or has had diarrhea, he may be dehydrated. In that case, we may want to give him fluids intravenously before the operation. We may also choose to give him antibiotics intravenously before the operation if we suspect that the appendix is already ruptured.

    What happens during and after surgery?

    The operation itself lasts about an hour and is done under general anesthesia. The operation may be performed either through a small incision in the right lower part of the abdomen, or laparoscopically, through three tiny incisions in the umbilicus and the lower abdomen. Both techniques achieve the same goal, removal of the appendix, and both produce similar results in terms of recovery.

    If the appendix has already ruptured, the operation may be more difficult and may last longer. Sometimes, a localized area of infection, an abscess, is found, and a drain is left inside, to be removed days later. If there has been a lot of infection and pus, the surgeon may find it safer to leave the skin open, to prevent more severe complications afterward. In that case, the wound will close by itself, over several days to weeks.

    Complications are frequent with appendicitis, and their risk increases with more advanced disease stages: while unlikely if the appendix is only mildly inflamed, the risk of a postoperative wound infection or an abscess inside the abdomen or the pelvis after ruptured appendicitis is quite high, sometimes reaching 30%.

    Your child will receive intravenous antibiotics during and shortly after the operation. Depending on the degree of inflammation and infection, antibiotics may have to be continued for several days after. If your child has recovered long before the antibiotics can be stopped, he may still be discharged home. In that case, a fine intravenous line will be left in his arm, to receive antibiotics at home. This will be done by a visiting nurse, as arranged before your child goes home.

    You will be expected to return to your surgeon's office within 2 to 3 weeks after discharge from the hospital.