Appendicitis in
children
Ahmed Said
What is Appendicitis?
Appendicitis is an infection or inflammation of the appendix,
a pinky-sized, tube-like structure part of the large intestine.
The appendix is in the right lower section of the abdomen in
most children.
Appendicitis is the most common cause of emergency
abdominal surgery in children. Though it can happen at any
age, appendicitis occurs more frequently in school-aged
children, and rarely occurs under the age of 1.
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What causes Appendicitis in a
child?
Appendicitis is the result of a blockage of the appendix
caused by hard mucus or stool, or swelling caused by a
virus. The blockage causes the appendix to swell and
become inflamed. If the swelling and infection are left
untreated, the appendix can perforate, causing the contents
of the appendix to be released into the abdomen, spreading
the infection.
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Signs of Appendicitis
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Sudden pain that
begins on the
right side of the
lower abdomen.
Sudden pain that
begins around
belly button and
often shifts to your
lower right
abdomen.
Pain that worsens
if you cough, walk
or make other
jarring
movements.
Nausea and
vomiting and
diarrhea
Fever and Loss of
appetite.
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How does a child act with
appendicitis?
The most common symptoms of appendicitis in children
are: Abdominal pain that begins around the belly button and
moves to the right lower side of the abdomen. The pain typically
increases when walking, jumping or coughing, and usually worsens as
time goes on.
Constipation and frequent urination.
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Stages of appendicitis
Early stage appendicitis
Obstruction of the appendiceal lumen leads to mucosal edema and ulceration------ The
child could experience mild epigastric pain lasts four to six hours.
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Stages of appendicitis
Suppurative appendicitis
Increased intraluminal pressure associated with obstructed lymphatic and venous
drainage-----Allows invasion of the appendix wall by bacteria and inflammatory fluid----- Child will typically experience the shift of pain from the umbilical area to the LRQ.
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Stages of appendicitis
Perforated appendicitis
Persisting tissue ischemia results in appendiceal infarction and perforation.
Perforation can cause localized or generalized peritonitis.
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Stages of appendicitis
Spontaneously resolving appendicitis –
If the obstruction of the appendiceal lumen is relieved, acute appendicitis may resolve
spontaneously. This occurs if the cause of the symptoms is lymphoid hyperplasia or
when a fecalith is expelled from the lumen. Treated only with Antibiotics
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Diagnostics and Lab Tests
Among laboratory tests, IL-6 is the best laboratory marker of acute
appendicitis, although it is only of medium diagnostic accuracy. White
blood cell count and C-reactive protein concentration in serum are of
low diagnostic accuracy and have only a supportive role in diagnosing
acute appendicitis in children.
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Diagnostics and lab tests
abdominal X-ray, an abdominal ultrasound, computerized
tomography (CT) scan or magnetic resonance imaging (MRI)
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What can be mistaken with
Appendix pain?
Appendicitis can easily be confused with something else, such
as:
•gastroenteritis.
•severe irritable bowel syndrome (IBS)
•constipation.
•bladder or urine infections.
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Physical Testing for Appendicitis
A health care provider tests for the obturator sign by asking the patient
to lie down with the right leg bent at the knee. Moving the bent knee
left and right requires flexing the obturator muscle and will cause
abdominal pain if the appendix is inflamed.
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Treatment
Some researchers has suggested that appendectomies aren’t
necessary to treat uncomplicated appendicitis, which is appendicitis
without a ruptured appendix, pus-filled abscesses, or peritonitis.
Instead, an antibiotic-only treatment can do the trick.
Although, most of the patients treated with Antibiotics only required
fewer doses of narcotics, returned to work quicker, and did not have a
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higher perforation rates, thay had
recurrent
appendicitis in one year.
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Complications after surgery
• Abnormal connections between abdominal organs or between these organs and the
skin surface (fistula)
• Abscess
• Blockage of the intestine
• Infection inside the abdomen (peritonitis)
• Infection of the surgical wound
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Thank you
Ahmed Said