Appendicitis is the swelling and infection of the appendix (a narrow, finger-like pouch that branches off the large intestine). Appendicitis is the most common reason for a child to need emergency abdominal surgery. Most cases of appendicitis occur between the ages of 8 and 30 years.
Appendicitis occurs when the interior of the appendix becomes filled with mucus, stool, or parasites. The appendix then becomes irritated and inflamed. The blood supply to the appendix is cut off as the swelling and irritation increase and the appendix starts to die. Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen. An infection inside the abdomen known as peritonitis occurs when the appendix perforates. An irritated appendix can rapidly turn into an infected and ruptured appendix, sometimes within hours, and this can be life threatening. When the appendix ruptures, bacteria infect the organs inside the abdominal cavity, causing peritonitis. The bacterial infection can spread very quickly and be difficult to treat if diagnosis is delayed.
Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, it is recommended to remove the appendix with an operation. It is done via two methods -:
Laparoscopic method (More commonly performed). This procedure uses 3 small incisions and a camera called a laparoscope to look inside the abdomen during the operation. Under anaesthesia, the instruments the surgeon uses to remove the appendix are placed through these small incisions, and the procedure is formed. This method may even be performed if the appendix has ruptured by surgeons with extensive experience with minimally invasive surgery.
Open method. This approach is rarely employed unless the process has been ongoing for several days and the inflammation is severe. Under anaesthesia, an incision is made in the lower right-hand side of the abdomen. The surgeon finds the appendix and removes it. If the appendix has ruptured, a small drainage tube may be placed to allow pus and other fluids that are in the abdomen to drain out. The tube will be removed in a few days, when the surgeon feels the abdominal infection has subsided.
After surgery, children are not allowed to eat or drink anything for a specified period of time so the intestine can heal. Fluids are given into the bloodstream through small plastic tubes called IVs until the child begins drinking liquids. Your child will also receive antibiotics and pain medications to help him or her feel comfortable. Eventually, children will be allowed to drink clear liquids (such as water or apple juice), and then gradually advanced to solid foods.
A child whose appendix ruptured will have to stay in the hospital longer than the child whose appendix was removed before it ruptured. Some children will need to take antibiotics by mouth for some period of time.
Most children who have their appendix removed will have no long-term problems.