Abdominal Pain: When To Call The Doctor
How to tell the difference between a bad stomach virus and appendicitis.
“My tummy hurts!” When most parents hear these words, they brace for a rough few days of a stomach bug (gastroenteritis), or vomiting and diarrhea caused by something their child ate. In some cases, belly pain can be explained by simple constipation. In other cases, it can be something worse – appendicitis.
The first symptoms of appendicitis generally include pain around the belly button. Other symptoms can include vomiting, nausea and loss of appetite. Unlike the less serious causes of abdominal pain mentioned above, appendicitis pain usually worsens and, within the first 12-24 hours, moves to the lower right side of the belly. If this happens, it’s important to consult a doctor as soon as possible.
So what is the appendix? It’s a small finger-shaped intestinal organ that sits at the beginning of the large intestine, just past the transition from the small intestine to the large. No one is really sure why we have this appendage. There is evidence to suggest that early humans needed it to aid in digestion, but today the appendix is completely unnecessary.
Appendicitis occurs when this organ becomes infected. Approximately 80,000 children in the United States suffer from appendicitis every year, and most of them are between the ages of six and 18. The standard treatment for typical appendicitis is a short and simple operation to remove the appendix before the appendix ruptures, which usually happens after symptoms have lasted 48-72 hours.
Appendicitis is the most common reason for emergency surgery in children. Although the thought of an operation is scary, it needn’t be thanks to laparoscopy, or minimally invasive surgery. With very small and specialized tools and scopes, pediatric surgeons can remove an infected appendix with a few small incisions. The average procedure time is 30 minutes, and most children with typical appendicitis go home the next day. Studies have been performed to determine if some children with appendicitis can be safely treated with antibiotics and not surgery. The complication rates in children treated without surgery are unacceptably high, and laparoscopic appendectomy remains the preferred treatment for children with typical appendicitis.
In about 20 percent of cases, the appendix will be perforated at the time of diagnosis, which means there is a small hole in the wall of the appendix. This is also known as a “ruptured” or “burst” appendix. When it occurs, the infection from inside the appendix leaks out into the abdomen. Children experiencing this condition usually have a longer recovery and are best treated with an extended course of antibiotics. Many children with perforated appendicitis receive surgery at time of diagnosis, but sometimes, if the appendix has been perforated for an extended period of time, the best treatment is initially just antibiotics, followed by “interval appendectomy” after the infection resolves. Interval appendectomy is usually out-patient surgery performed eight to 12 weeks after the initial diagnosis.
For many parents, appendicitis is their first exposure to pediatric surgery. They may not know what to ask when a surgeon is referred to them. Please remember that it is your right to choose the surgeon who will operate on your child, and you should feel very confident in your pediatric surgeon’s abilities. To ensure the best outcome, look for a board-certified pediatric surgeon. Then ask as many questions as you need to feel comfortable.
Dr. Graham Cosper is a board-certified Pediatric Surgeon with Pediatric Surgical Associates in Charlotte. For more information on keeping your child safe and well, visit www.pedsurgical.com.