Stomach Pain in Kids – Could it be Appendicitis?

Appendicitis is a relatively common condition for children ages 8 to 18 and also young adults. It happens within the appendix, a small out-pouching of the large intestine (the colon) that is located on the right side of the abdomen near the pelvis. About the size of a pinkie finger, the appendix doesn’t really have any important function within the human body, which is ironic because it can cause a lot of trouble if it gets inflamed and infected – also called appendicitis.

What Causes Appendicitis?
Almost all the time, food travels normally through the intestine.  But over months, or even years, small pieces of food can get “off track” and build up to create a plug in the appendix. This plug is called a fecalith and is probably the most common cause of appendicitis.

Signs & Symptoms
Many cases of appendicitis begin with stomach pain that is first located around the belly button and then moves to the right side of the stomach. The pain is usually constant and persistent – it does not come and go. It is exacerbated by movement, for example a bumpy car ride. A child who is experiencing appendicitis might be expected to moan in pain and won’t be able to jump up and down. He or she also might hunch over when trying to walk. Other symptoms could include:

  • Nausea
  • Vomiting (one to three times, usually not much more)
  • Low-grade fever (100 to 100.5 degrees F)

When to See a Doctor
If you think your child is exhibiting symptoms of appendicitis, you should immediately call your child’s pediatrician or primary care doctor. If the case is severe enough, you might be advised to go to a children’s emergency room, such as the WakeMed Children’s Emergency Department. There is great value in going to a place where the nurses, doctors and other care providers see children all the time and are also familiar with seeing kids who are suffering from a condition like appendicitis.

Treatment
In about 90 percent of cases where bad abdominal pain is the concern, a viral illness or something similar that doesn’t require emergency intervention,  is the culprit. However, if appendicitis is the diagnosis, IV antibiotics will be administered immediately.

Most cases will then involve a laparoscopic appendectomy, or a minimally invasive procedure for appendix removal. In only about  two percent of cases is traditional “open surgery” for appendix removal still necessary.

Both procedures include the use of general anesthesia which is very safe for children. In extreme cases, the appendix may rupture, which can be life-threatening.

Recovery
Early acute appendicitis usually involves an overnight hospital stay and, in five to seven days, the child can go back at school. Gradually, he or she can return to normal activities. More complicated cases can involve a five- to six-day hospital stay. 

By the Numbers
There are usually no long-term effects of having your appendix removed. In fact:

  • Appendectomy is the single most common emergency abdominal surgery for kids in the United States.
  • One out of 13 Americans will have an appendectomy in their lifetime. 
  • 70,000 to 80,000 kids in our country have appendectomies every year, making it extremely common.

The most important thing to remember: If your child’s symptoms are concerning, call your pediatrician or primary care doctor right away and describe what’s going on.  He or she can help guide you on what to do next.

J. Duncan Phillips, MD, FACS, FAAP, is surgeon-in-chief of the WakeMed Children’s Hospital and director of Pediatric Surgery.

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