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Appendicitis: The Stomachache To Worry About

Kids complain of stomachaches often. This happens because just about every medical problem can have some symptom manifestation in the abdomen (e.g., strep throat and migraines often present with abdominal pain). Whenever I hear the complaint of “stomachache” (which in kid terms doesn’t necessarily mean the stomach, but rather the whole abdomen typically), I have an endless list of possible diagnosis. I want to address one, key diagnosis that you (and your doctor) don’t want to ever miss: appendicitis.

What is appendicitis?

The appendix is a little 3.5” outpouching off the large intestine. If the appendix gets blocked (usually by stool passing through the intestine or infection), it gets inflamed. When it gets inflamed, it hurts. If it goes untreated, it can rupture and spill infection into the rest of the abdomen. This complication is very serious and can be life threatening. In all my years of study, I’ve yet to determine an actual necessary function for the appendix.

How common is appendicitis?

The touted statistics are that 1 in 15 people will have appendicitis. It is the most common disease requiring surgery in children.

Who gets appendicitis?

Appendicitis can happen at any age, but typically happens between ages 10 and 30 (with a huge peak in the teen years). It almost never happens to children under the age of 2.

What are the appendicitis symptoms?

  1. Abdominal Pain. In the beginning the pain is usually around the belly button (i.e., periumbilical). As the inflammation increases, the pain moves to the right lower quadrant of the abdomen. The pain has been described as pressure and fullness. The classic kid who comes into my office, is lying on the table, bent over, holding the abdomen, and doesn’t want to move.
  2. Loss of appetite. (I have never seen a kid with appendicitis want to eat.)
  3. Nausea or vomiting
  4. Fever
  5. Tight, rigid abdomen
  6. Abdominal swelling
  7. Elevated white blood cell count (a blood test)

How is appendicitis diagnosed?

First and foremost is always the history and physical. The doctor has to determine if the story and exam findings fit the possible diagnosis. Then there is often imaging done to confirm the diagnosis. Over the years, there has been debate on what the best modality is. Currently the American College of Radiology recommends ultrasound first (claiming a 96% accuracy rating). The advantage is that ultrasounds are relatively inexpensive and have zero radiation risk. The downsides are that they are user-dependent and some facilities don’t have them readily available (ultrasound techs aren’t necessarily staffed 24/7 in hospitals). Ultrasounds are also hard to get on obese patients and uncooperative patients.

The other commonly used diagnostic test is a CT scan. CT scans are readily available in hospital ERs (24/7) and can be done easily even if the patient is obese or uncooperative. The downside is that they are often more expensive and there is radiation risk associated with them.

How is appendicitis treated?

  1. Surgical removal: Surgically removing the appendix is considered the treatment of choice. This is often done by a laparoscopic procedure (using a flexible camera and a couple of tiny slits to insert instruments). The procedure can also be done in a traditional “open” surgery (meaning the surgeon just cuts you open to operate).
  2. Antibiotics: Sometimes a course of IV antibiotics will be given if there is believed to be an abscess or there is going to be a delay in surgical removal of the appendix (e.g., the next morning).

What should I do if my kid has some appendicitis signs?

In medicine, I often advise parents to watchful waiting. If you suspect appendicitis in your child, you should not delay seeking medical care. A possible appendicitis is definitely worthy of an ER trip. When you decide to take your child to the ER, you may want to pause and consider a couple of things:

  1. Is the hospital I’m considering going to, equipped and able to operate on a child? (Some smaller community hospitals won’t operate on children under 8 years of age, especially if there is a relatively close children’s hospital or bigger affiliated hospital.)
  2. Does the hospital you are considering going to, take your insurance? If you have no other options, go to the nearest hospital (regardless of insurance). If however, you have choices, you may want to choose the “in network” option since surgery can be expensive.

Good luck! Hopefully none of you or your children experience appendicitis.