KOCHI: The appendix is at the beginning of the large intestine — a small tubular structure. It has no definite known function. The position of the appendix within the abdomen varies. The tip can go down, towards the sides or even upwards. However, this small organ can also cause intense pain.
What is Appendicitis?
Appendicitis refers to the inflammation of the appendix. It can be simple or complicated. It is a common cause of abdominal pain in children. It also comes in acute, chronic and recurrent forms.
Acute is the sudden inflammation. It might improve with antibiotics but may also progress towards the complicated form. Recurrent inflammation might occur in some. Chronic inflammation occurs over a long period of time.
Complicated appendicitis is when the appendix perforates or bursts. This can lead to peritonitis which is a spread of infection throughout the entire abdominal cavity. Another possibility is that the pus can be localised or present in a specific area. The other intestinal loops or fat within the abdomen can move towards this perforated appendix and form an abscess.
What are the symptoms?
Appendicitis can occur at any age. Also, it is commonly seen in children between the ages of nine and 12. It is also seen in infants.
Abdominal pain: It is usually the earliest symptom. The pain begins usually around the umbilicus or navel and within a few hours spreads or shifts to the right lower side of the abdomen. The pain worsens with increasing inflammation but can suddenly reduce when the appendix bursts. The pain then increases again. The pain is worse with sudden jerks or jolts to the body.
Loss of appetite: The child usually does not feel like having food and can have nausea. Vomiting can also develop when the condition progresses.
Fever: Constipation and fever are some other common symptoms.
Rarer ones: Based on the location of the tip of the appendix, symptoms vary. If the inflamed tip is close to the urinary bladder, there can be an urge to urinate frequently. If the tip or the pus collection (abscess) is close to the rectum and anus, it may cause diarrhoea.
The child may bend forward (stooping) due to the pain. On examining the abdomen, there will be pain in a particular spot, especially on the right side of the lower part of the abdomen, called McBurney’s point. Other signs like pain on the left side while pressing on the right side of the abdomen can also be diagnosed as Appendicitis.
Causes
When the appendix is blocked either by particles of stool, swollen lymphatic patches or swallowed seeds. Also, the appendix can get inflamed rarely due to tumours.
Diagnostic tests
Blood test: Increased white blood cell or leucocyte count in the blood test is an indication. A very high count can indicate complicated appendicitis. Another parameter is the elevated value of CRP.
Ultrasound scan: It is helpful to locate the inflamed appendix and also to see if complications like abscess formation have occurred. It is also helpful in females to eliminate the other causes of abdominal pain like ovarian problems. However, the appendix may not be always seen due to gas in the bowel or its position.
CT scan: When the child has symptoms of appendicitis and other tests fail to confirm the condition, a CT scan is useful. It also helps to locate the appendix in unusual positions and also to find out the factors of complication.
Treatment
Treatment involves intravenous Antibiotics and surgical removal of the inflamed appendix (appendicectomy). Acute appendicitis may subside in a few children. Once a week of antibiotics is completed, we can keep them under follow-up and plan to remove the appendix after 6-8 weeks.
In case of complications, appendicectomy should be done as early as possible. Appendicectomy can be done by open or laparoscopic method. Laparoscopic or keyhole surgery is very common now as it has a few advantages.
The recovery from appendectomy is quick but for complicated appendicitis, it is prolonged. So the earlier the disease is diagnosed and treated, the faster the child recovers.
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The writer is a consultant paediatric surgeon at SUT Hospital, Pattom