Appendicitis 101: Commonly Asked Questions

Children with appendicitis present later in the disease process than adults because it is difficult for them to communicate their symptoms to caregivers.  A “simple” appendicitis (one that has not burst) usually only requires an overnight admission, while a “complicated” appendicitis (one that has burst) may require a hospital stay. Up to 40 percent of children present with complicated appendicitis due to the delay in starting treatment. What is an appendix? Inside the abdomen is a small, tubular structure attached to the large intestine and it is called the appendix. The appendix only has one opening and does not have a functional purpose. The body works the same with or without it. What causes appendicitis? Appendicitis occurs when the single opening gets blocked. It is most commonly blocked by a small piece of hard stool called a fecolith. Once the opening is blocked, infection by bacteria normally present in the intestines begins to attack. Pressure builds inside the appendix from the infected fluid and multiplying bacteria until the appendix bursts (perforation) inside the abdomen. Once this occurs, germs from the appendix can spread throughout the body; however, it can’t spread to other people.  A diet high in fiber and avoiding constipating foods like pasta, macaroni and cheese, fried foods and pizza can help prevent appendicitis. What are the symptoms of appendicitis? Often, children with appendicitis will complain of a stomachache around the belly button.  As several hours pass, the pain will become more severe and move to the lower, right side of the abdomen and become tender to the touch. The location of the appendix can vary from one person to the next and this can alter symptoms which may include loss of appetite, nausea, vomiting, a low-grade fever, abdominal swelling, constipation or diarrhea. How do you treat appendicitis? The standard treatment for appendicitis in children is powerful (broad spectrum) IV (intravenous) antibiotics. Once antibiotics are started, the inflammation and infection begins to resolve and prevents perforation if it has not yet occurred. In most cases, the appendix is then surgically removed – this is called an appendectomy –  to prevent additional episodes of appendicitis and to shorten the course of antibiotics. In some select cases, or if surgery is unavailable (like on a cruise ship), only antibiotics are used. Severe cases of perforation may form collections of pus in the abdomen called an abscess. These may require a separate drainage procedure and delaying of the appendectomy for several weeks while the infection clears to make the surgery safer. For more information about Texas Children's Department of Surgery, visit here.