Our Summary

This paper discusses acute appendicitis, which is the most common reason for abdominal surgery in children. Appendicitis occurs when the appendix, a small pouch in the abdomen, becomes blocked and inflamed, which can cause it to burst and lead to a serious infection. The classic symptoms include belly button pain that moves to the lower right side of the abdomen, loss of appetite, fever, and tenderness in the lower right side of the abdomen. However, these symptoms can be different in young children.

Doctors can usually diagnose appendicitis through a physical exam, but sometimes blood tests and ultrasound scans are needed for confirmation. The treatment for appendicitis is to remove the appendix in a surgery called an appendectomy. Before surgery, the child is given fluids, pain medicine, and antibiotics. The paper suggests that removing the appendix through small incisions (laparoscopic appendectomy) is better than open surgery because it causes less pain after surgery and requires a shorter hospital stay. However, the child’s recovery largely depends on whether the appendix had burst or not.

The paper also discusses some controversies about how to manage an appendix mass, which is a lump that can form if the appendix bursts. Not all children with an appendix mass need to have an appendectomy.

FAQs

  1. What is the most common reason for abdominal surgery in children?
  2. What are the typical symptoms of acute appendicitis in children?
  3. What is the preferred method of treatment for acute appendicitis in children and why?

Doctor’s Tip

A helpful tip a doctor might tell a patient about appendectomy is to follow their post-operative care instructions carefully, including taking prescribed antibiotics, avoiding strenuous activity, and watching for signs of infection such as increased pain, redness, or drainage from the incision site. It is important to follow up with the doctor for any concerns or complications that may arise after surgery.

Suitable For

Patients who are typically recommended for appendectomy are those who present with symptoms of acute appendicitis, such as periumbilical pain migrating to the right iliac fossa, anorexia, fever, and tenderness and guarding in the right iliac fossa. Atypical presentations are common in preschool children, so a clinical diagnosis may be more challenging in this population. In cases where the diagnosis is uncertain, inflammatory markers and an ultrasound scan may be useful investigations.

Treatment for acute appendicitis typically involves appendicectomy after appropriate fluid resuscitation, analgesia, and intravenous antibiotics. Laparoscopic appendicectomy is generally preferred over open appendicectomy as it is associated with less postoperative pain and a shorter hospital stay. However, recovery after acute appendicitis is primarily determined by whether the appendix was perforated or not.

The management of an appendix mass is controversial, and not all affected children may require an interval appendicectomy. It is important for healthcare providers to be aware of the tips and pitfalls in diagnosing acute appendicitis and to consider the various controversies surrounding its management.

Timeline

Before appendectomy:

  • Patient experiences periumbilical pain that migrates to the right iliac fossa
  • Anorexia
  • Fever
  • Tenderness and guarding in the right iliac fossa
  • Possible ultrasound scan and inflammatory markers to confirm diagnosis
  • Treatment with fluid resuscitation, analgesia, and intravenous antibiotics

After appendectomy:

  • Recovery time depends on whether the appendix was perforated or not
  • Laparoscopic appendicectomy is associated with less postoperative pain and shorter hospital stay
  • Not all patients with an appendix mass may need an interval appendicectomy
  • Management may involve active observation and appropriate follow-up care

What to Ask Your Doctor

  1. What are the symptoms of appendicitis and how is it diagnosed?
  2. What are the benefits and risks of having a laparoscopic appendectomy versus an open appendectomy?
  3. How long is the recovery time after surgery and what post-operative care is needed?
  4. Are there any potential complications or risks associated with the surgery?
  5. Is there a possibility of needing further treatment or follow-up after the appendectomy?
  6. What are the alternative treatment options for appendicitis?
  7. How soon after symptoms appear should surgery be performed?
  8. Will there be any dietary or activity restrictions after surgery?
  9. How can appendicitis be prevented in the future?
  10. What is the success rate of appendectomy in treating appendicitis?

Reference

Authors: Stringer MD. Journal: J Paediatr Child Health. 2017 Nov;53(11):1071-1076. doi: 10.1111/jpc.13737. Epub 2017 Oct 17. PMID: 29044790