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Appendicitis

  • The appendix sits in the lower right side of the abdomen (stomach). It is quite small and is a normal part of the bowel, but it is not thought to have an important role in the body. 

    Appendicitis is an inflammation of the appendix. Inflammation is most commonly caused by a small, hard piece of faeces (poo) getting stuck in the tube of the appendix. If the appendix is inflamed it is usually necessary to remove it with an operation called an appendicectomy (uh-pen-deh-sect-a-me).

    Anyone can get appendicitis, but it tends to occur in older children and teenagers. It is rare for someone under the age of five years to get appendicitis. As a common condition, it can occur in multiple family members by chance - it is not a genetic condition.

    Signs and symptoms of appendicitis

    There are many variations of the symptoms of appendicitis. Symptoms may include:

    • pain that starts around the belly button, then moves to the right side of the abdomen
    • fever
    • loose poo
    • nausea and sometimes vomiting
    • loss of appetite.

    When to see a doctor

    If you think your child has appendicitis, take them to your GP or local emergency department. A diagnosis of appendicitis is important because the inflammation causes the appendix to swell, and sometimes it can leak its contents into the stomach. This can make your child very sick.

    If your child is in significant pain, which is made worse by moving or touching the stomach, go straight to your local emergency department.

    How is appendicitis diagnosed?

    The doctor will ask for a history of your child's symptoms and illness. They will examine your child by checking the site of the pain and pressing on the abdomen.

    Sometimes it can be difficult to work out the cause of stomach pain as there are many possible reasons. If the doctor is not sure if it is appendicitis, they may keep your child in hospital and watch them to see if their symptoms get worse. Sometimes tests will be performed to help work out what is going on, but these tests are not always helpful or reliable. 

    Your child may need an ultrasound or X-ray to take pictures of their abdomen. The doctor may also do a blood test to look for signs of infection or inflammation. In cases where children are sick and it is not clear why, your doctor may recommend an operation to check the appendix even if they are not certain it is inflamed.

    Treatment for appendicitis

    Most cases of appendicitis need an operation called appendicectomy. The appendix is normally removed through a keyhole operation with three, small keyhole cuts about 1-2cm long each, made in different parts of your child's abdomen. Rarely an open operation will need to be performed through a larger incision.

    When a diagnosis of appendicitis is made, your child will be given antibiotics. Antibiotics will stop your child's appendicitis getting worse while they wait for their operation. 

    Before the operation

    A surgeon, an anaesthetist (a doctor who puts your child to sleep during the operation) and nurses will explain all the procedures to you before they begin. If you have any questions or anything is unclear, ask staff to explain as many times as needed.

    After the operation

    After the operation, your child can be given medicine directly into a vein through a drip (intravenous or IV therapy) to stop them feeling sick or vomiting.

    Your child may need to have pain medicine, and some will be given antibiotics through the drip to prevent infection of the wound.

    The time your child will be in hospital for depends on what is found during the operation. Some children can go home the day after surgery, most after a couple of days and a few will need to be in hospital for five or more days.

    Eating and drinking

    After the operation, your child will be given fluids through their IV drip until they can eat and drink again. This may be four to six hours after the operation.

    Doctors will tell you when and what your child can eat and drink. It is very important to follow staff instructions. The bowel may need to be empty of food or fluid so it can rest after the operation.

    Care at home

    When your child comes home from hospital, they should:

    • Stay home from school for one week and avoid sports for two weeks, but these times will depend on how sick your child has been. Always ask your surgeon if you're not sure.
    • Be able to eat and drink as normal.
    • Be able to shower and bathe as normal.
    • Be in minimal pain. You can give paracetamol or ibuprofen as directed, if your child is in pain. See our fact sheet Pain relief for children.
    • Any sutures will be dissolving and you will be told what to do about any dressings your child has.

    Follow-up

    After you leave the hospital, a follow-up appointment will be made for your child to come back and see the surgeon.

    There is a small risk of developing an infection or a bowel blockage after having a burst appendix. Contact your GP or take your child to the local emergency department if:

    • your child gets a persistent fever (above 38.5°C)
    • the wound starts to look infected (e.g. it looks red and inflamed, has a discharge, or it becomes more painful)
    • your child has increasing pain that is not controlled by paracetamol or ibuprofen.

    Key points to remember

    • A diagnosis of appendicitis is important because a burst appendix can make a child very sick.
    • An appendicectomy is an operation to remove the appendix. The appendix is not useful to the body.
    • Your child will be in hospital for one to five days depending on the severity of the appendix infection.
    • Once you are home from hospital, contact your surgeon if you think your child is developing an infection.

    For more information

    Common questions our doctors are asked

    How can I tell if my child has appendicitis or if it is just gastro?

    It can sometimes be difficult to tell what it causing your child's stomach pain, because many of the symptoms of gastro and appendicitis overlap. Generally, the pain will only be in the right side of your child's stomach if it is appendicitis, and any vomiting or diarrhoea will be mild.

    If your child has bad pain or persisting symptoms, see your GP.

    What is mesenteric adenitis?

    Mesenteric adenitis occurs when the lymph nodes in the abdomen enlarge in response to an infection – most commonly a viral infection. This causes stomach pain. The symptoms of mesenteric adenitis are similar to the symptoms of early appendicitis, but do not progress in the same way. 

    What are the risks of surgery to remove the appendix?

    All operations have some risks associated with them, such as the risk of bleeding or infection. Complications due to surgery on the appendix are uncommon. Talk to your surgeon and anaesthetist about any concerns you have.


    Developed by The Royal Children's Hospital Surgery Department. We acknowledge the input of RCH consumers and carers.

    Reviewed August 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

Disclaimer  

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.