The appendix in a finger-like extension of the large intestine. It has no known function in humans. However, serious illness can result if the opening of the appendix becomes blocked. Blockage can lead to pressure within the appendix which leads to tissue injury and inflammation, a condition called appendicitis. If not treated in a timely manner, the wall of the appendix can break open (rupture) and allow spread of bacteria from the intestine to the abdominal cavity. The resulting inflammation is called peritonitis.
The most important symptom of appendicitis is persistent pain in the lower right abdomen. Fever, loss of appetite, and vomiting are also common symptoms. Small children with poor communication skills may show increased irritability and a reluctance to move about normally.
The diagnosis of appendicitis is made best by physical examination of the abdomen. Ultrasound and CT scan examinations are sometimes useful when the cause of a child's abdominal pain is not clear after physical examination. Blood will be drawn to check for the presence of an infection (elevated white blood cell count).
An operation to remove the appendix (appendectomy) is the only effective treatment for appendicitis, except under unusual circumstances when there is a well-developed abscess next to the appendix. In this case, the abscess might be drained with a needle, intravenous antibiotics administered, and the appendix removed six weeks later.
Intravenous antibiotics will be started prior to the operation to limit the spread of infection. The operation is performed with your child completely asleep. The procedure can be performed either through a small incision in the abdomen or with the aid of a laparoscope. When the laparoscope is used, three small "stabs" are made in the abdominal wall through which a camera and instruments are passed. Your child's surgeon will decide which method best meets the needs of your child and their condition. A watertight, clear dressing will be used to cover the incision and your surgeon will instruct you when this outer dressing can be removed.
During the operation, parents are asked to wait in the Children' s Hospital waiting area located on the lobby level. After the operation, your child will be recovered in the Post Anesthesia Care Unit for one to two hours before they are returned to a pediatric unit.
The hospital stay
Nurses will make every effort to keep your child comfortable and pain-free. The pediatric surgery team will make rounds as a group daily. We are available to answer any questions you may have concerning the progress of your child.
Nurses will encourage activity out of bed, including walking the first day after the operation. Activity helps to stimulate the return of intestinal function.
Pain medication will be administered through the IV which was started prior to the operation. When your child is eating well, pain medication will be given by mouth.
- IV tubes: All children return from the operating room with attached IV (intravenous) tubing. This tubing connects to the child's circulation by a catheter inserted into a vein. The IV allows delivery of routine or emergency medications during anesthesia, and it also provides a way to deliver fluids, antibiotics, and pain medication after the operation.
- NG(nasogastric) tube: An NG tube may be required. It passes through the nose and into the stomach. It is usually inserted in the operating room and is used to prevent vomiting, gas, and abdominal bloating. Children with uncomplicated and early appendicitis rarely require and NG tube. Children with advanced appendicitis or a ruptured appendix often require removal of intestinal gas and secretions by NG tube. The NG tube remains in place until the volume of output has decreased.
If the appendix did not rupture and an NG tube is not needed, clear liquids by mouth are usually started the first day after the operation. The diet is then advanced to normal if the child tolerates the clear liquids (no vomiting or nausea).
Children with perforation of the appendix are started on clear liquids once the child has passed gas or stool from the rectum. Again, as long as the child is tolerating the clear liquids, diet is advanced.
The wound is closed with absorbable sutures and will have a clear, watertight dressing in place. Your child's surgeon will ask that the dressing remain in place for at least two days and that your child stay out of the bathtub for two days. If your child had a laparoscopic appendectomy, they will have small plastic dressings covering the stab sites. Again, please keep your child out of the bathtub for two days.
Always wash your hands before touching or cleaning the incision area. Some blood staining of the paper tapes on the incision is common. If the blood is dry and not spreading, the staining is not a problem. If the blood seems fresh, the amount is increasing, or if the paper tape is blood soaked and partially floating above the skin, apply gentle pressure with a clean washcloth for five to six minutes. Then contact the pediatric surgery resident on call (909) 558-4000. The problem is usually minor but the surgeon needs to know about it.
Length of stay
Hospital stay averages two to three days after the operation if the appendix was not perforated and there were no complications.
A longer stay of five to seven days is required for treatment of a perforated appendix. Bowel function normally returns after two to four days, but intravenous antibiotics are required for at least four to five days and sometimes longer, depending upon the child's fever and white blood cell count. When the appendix is perforated, the chance for an infection of the incision site are about five to ten percent and the chance that an abscess (pus collection) will develop inside the abdomen is less than five percent. If a wound infection develops, the would will be opened partially and dressing changes begun. If there is an abscess inside the abdomen it is usually possible to drain it by insertion of a needle without the need for re-operation. These complications may delay discharge if they occur.
After appendectomy, children may usually return to school within a week of discharge from the hospital, although they may find that they tire quickly. Vigorous activities and contact sports should be limited for at least three weeks. When the appendectomy is done using a laparoscope, children may resume their usual physical activities as soon as they feel ready--there are no activity constraints.
When to call your child's surgeon
- Fever above 101oF that does not come down with Tylenol (mild fever is common)
- Persistent vomiting
- Difficulty breathing, with or without a croupy cough
- Active bleeding from the incision
- Redness, swelling, drainage of fluid, or persistent pain in the incision
A clinic appointment needs to be scheduled one to two weeks after the operation. Please call (909) 558-4848 to schedule this appointment.