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Appendicitis

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is the appendix?

The appendix is a coiled, eight to twelve centimetre tube attached to the caecum (the first part of the large intestine), usually located in the lower right side of the abdomen.

What is appendicitis?

Appendicitis is inflammation of the appendix. This can be caused by an infection or blockage of the appendix. With a blockage, the appendix can become swollen and easily infected by bacteria. If the diagnosis is delayed, the appendix can rupture. This results in peritonitis or the formation of an abscess around the appendix.

What are the most common signs and symptoms of appendicitis?

• Abdominal pain that starts near the belly button, then moves to the right side
• Fever
• Vomiting

How can the doctor be sure its appendicitis?

The diagnosis of appendicitis can usually be made by examining your child and discussing their symptoms. Blood tests, an ultrasound or other investigations may be done if the diagnosis is less certain. A period of observations in hospital is often more useful that tests. The diagnosis can be more difficult in younger children. Sometimes, the diagnosis isn't suspected until the appendix has ruptured. In a small number of cases, the diagnosis is suspected but the symptoms prove to have another cause.

Treatment of appendicitis

The best treatment of appendicitis is removal of the appendix. The operation may be done through a single incision over the appendix or by laparoscopy ('key hole' surgery). Antibiotics are given at the time of the operation to reduce the chance of infection.

About one in five children who have an operation for appendicitis turn out to have another cause for their pain. This has to be balanced against the risk of the appendix rupturing if the operation is unduly delayed. The surgical team will discuss the factors in the decision to operate in detail with you.

What happens to my child before going to theatre?

• Your child must not eat or drink ('nil by mouth') to empty the stomach before the operation.
• Your child's condition is watched with regular observations of temperature, respirations, pulse and any changes in behaviour or level of pain.
• The doctor or nurse will explain the operation to you.
• Your child may be given intravenous fluids.
• A nasogastric tube (a tube through the nose to the stomach to keep the stomach empty and prevent vomiting) may be used.

Any other treatment needed before the operation will be explained by the doctors and nurses looking after your child. You should feel free to ask questions at any time.

What happens after operation?

• Your child is watched hourly for four hours, then as often as is necessary depending on his/her condition.
• The wound is checked regularly.
• Pain relief will have been ordered by the anaesthetic team and will be given by the nurses in the ward. The details of this will be explained to you. Antibiotics will be continued intravenously if the appendix was ruptured.
• Usually drinks, followed by food can be started the next day. This may be delayed if the appendix was ruptured or your child is nauseous or vomiting. Meanwhile, fluid is given through a drip to avoid dehydration.
• The Hospital stay is usually two to four days, but may be longer if the appendix was ruptured.

Prevention

There are no medically proven ways to prevent appendicitis.

• Children with appendicitis can deteriorate quickly.
• If you suspect appendicitis, go to your family doctor or local hospital without delay.
• Feel free to ask any questions of the doctors and nurses caring for your child.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au	Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au