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Appendicitis

What is appendicitis?

The appendix is a small, narrow pouch attached to the large intestine. It is in the right lower belly (abdomen).

Appendicitis is swelling (inflammation) of the lining or wall of the appendix. Usually this happens because stool (feces) or small, stone-like pieces of stool (called fecaliths and pronounced FEE-kah-liths) block the opening to the appendix or a viral illness makes the appendix swell and become blocked. Then bacteria in the appendix grow and cause infection. The appendix swells and causes pain.

If it's not removed, an inflamed appendix may burst, or perforate. This can spread infection around the abdomen and lead to serious problems.

The appendix doesn't do anything for your child's body. By removing it, your child will not be missing something their body needs.

Who gets appendicitis?

Anyone can get appendicitis. It's most common between the ages of 4 and 15. About 7% to 9% of people get appendicitis at some time in their life.

What are the symptoms?

The most common symptom is pain in the abdomen. It's often hard to tell appendicitis from other causes of belly pain. An older child may first complain of pain near the belly button. Over time, the pain moves to the lower right belly. In most cases the pain doesn't get better even if the child lies still. Movement tends to make the pain worse.

Your child may have these symptoms, too:

  • Not wanting to eat
  • Feeling sick to their stomach
  • Vomiting
  • Diarrhea
  • Fever
  • Swollen or bloated belly

Children may have a slight fever at first. If the appendix bursts, your child may get a high fever (around 104 degrees Fahrenheit) because of the spreading infection.

How do you diagnose appendicitis?

The doctor will ask for a detailed history of your child's illness and pain. The doctor will also examine your child's abdomen. A blood test and urine test may be helpful to find out the cause of your child's pain. Your child may also need an X-ray, ultrasound or a CT scan (short for "computed tomography scan" and sometimes said "cat scan") so the doctor can see inside the belly. This can help doctors tell whether the pain is from the appendix or caused by some other illness.

What is your experience with appendicitis at Children's Hospital?

Our surgeons treat many children with appendicitis. In fact, this is the most common emergency surgery that our General & Thoracic Surgery Department performs.

When you come to Children's, you have a team of people to care for your child before, during and after surgery. Along with your child's surgeon, you are connected with nurses, child life specialists and others. We work together to meet all of your child's health needs and help your family through this experience.

Since 1907, Children's has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia or pain medicine are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.

How do you treat appendicitis?

Your child will need surgery to remove their appendix (called an appendectomy). In many cases, this surgery will take place shortly after the diagnosis is made.

If doctors believe the appendix has already burst and the belly is badly infected, they sometimes delay surgery and give antibiotics first. The timing of your child's surgery will depend on your child's condition and response to treatment.

Surgery

Before surgery, your child will need an IV (short for intravenous) line. This is a tube that goes into a vein. It is a way to give antibiotics to protect against infection and to replace fluids lost from inflammation and vomiting.

At the time of surgery, your child will have general anesthesia. This means we will give your child medicine to make them sleep without pain during the surgery. The surgeon will take the appendix out either through a single small incision or laparoscopically. In laparoscopic surgery, the surgeon makes a few small incisions and inserts a thin, lighted tube with a camera and the surgical tools. Laparoscopic surgery is also called minimally invasive surgery.

Either way, the surgery takes about one hour. Your child will be in the recovery room for another hour, and we will give them pain medicine to make them comfortable.

After surgery

If the appendix has not burst, you can expect your child to stay in the hospital for one to two days after surgery. Your child will get antibiotics through an IV right after surgery.

If the appendix has burst, your child will need a longer stay in the hospital, probably about five to 10 days. Your child will get antibiotics and fluids through an IV during this time. They may also need a tube that passes through their nose into their stomach. This is called a nasogastric tube, or NG tube. The NG tube will help keep your child's stomach empty for a few days and allow the intestines to rest. Your child will not be able to eat or drink right away after surgery because it would likely cause them to vomit. The NG tube helps prevent this.

After your child goes home, you'll need to keep the incision clean and dry until it heals. The surgery team will teach you how to care for the incision, explain what kinds of food or medicine to give your child, and tell you if you need to limit your child's activity for a while.

About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.

Resources

Read more about what to expect when your child visits a clinic at Children's, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child's care team. You can also take a virtual tour of our surgery rooms and other parts of the hospital.

To learn more about this condition, you may want to visit our resource list.