abdomen and bowel · emergency
Acute appendicitis in children
Inflammation of the appendix, a small structure connected to the bowel.
Acute appendicitis
Acute appendicitis is an inflammation of the appendix, a small structure connected to the bowel. It is one of the most common causes of acute abdominal pain that may require a surgical assessment in children.
Symptoms may vary depending on the child’s age and the position of the appendix. For this reason, when abdominal pain persists or is associated with a worsening general condition, it is important not to underestimate it.
Symptoms and signs to look out for
The most typical signs to look out for are:
Causes or associated factors
Acute appendicitis is linked to an inflammatory process of the appendix. It may appear suddenly and develop differently from child to child.
Not all abdominal pain is appendicitis. If the pain remains unchanged for several days, without other symptoms, it is less likely to be acute appendicitis. However, medical assessment is important to distinguish between the different possible causes of abdominal pain.
In boys, in case of acute abdominal pain, the differential diagnosis should always also consider testicular torsion, an urgent condition that may present with radiating pain or symptoms that are not always immediately attributable to the testicle.
When to book a consultation
It is necessary to contact a doctor or go to the emergency department promptly in case of worsening general condition, significant pain, persistent pain or worsening of the clinical picture.
It is particularly important not to wait if the child appears weak, suffering, refuses food, has fever, vomiting or pain located in the lower right part of the abdomen.
In boys and adolescents, in the presence of acute abdominal pain, it is also important to consider testicular torsion among the possible diagnoses to rule out, because it may sometimes present with pain referred to the abdomen and is an urgent condition.
Assessment and diagnosis
Diagnosis is based first of all on medical examination, with collection of the clinical history, assessment of symptoms and physical examination.
When necessary, further tests may be requested, including:
● abdominal ultrasound
● blood tests
● any further investigations depending on the clinical picture
The diagnostic pathway is used to confirm the suspicion of acute appendicitis and to rule out other possible causes of abdominal pain.
How it is treated
The treatment pathway depends on the clinical assessment and test results.
When the diagnosis of acute appendicitis is confirmed, treatment generally involves:
● consultation and surgical assessment
● pre-operative tests
● surgery
Management may vary depending on the condition of the appendix, whether or not perforation is present and the child’s general condition.
When surgery is needed and what it involves
Surgery is indicated when the diagnosis of acute appendicitis is confirmed.
Appendicectomy consists of removing the appendix. It may be performed using an open technique, meaning traditional surgery, or a laparoscopic technique, which Dr Rapuzzi recommends when indicated.
The operation is performed under general anaesthesia and requires hospital admission.
The hospital stay may last approximately 3 days in early cases and up to 10–14 days in more complex cases, such as perforated appendix or peritonitis.
Recovery and useful instructions
After surgery, recovery depends on the clinical picture found.
If the appendix is not perforated, the post-operative course may be shorter, approximately 1–3 days. In case of perforation or peritonitis, hospital stay and recovery may be longer, up to 7–10 days or even 10–14 days in more complex cases, depending on clinical progress.
In general, after surgery Dr Rapuzzi advises:
Instructions may vary depending on the surgical technique, post-operative progress and the child’s clinical picture.
Parents’ most common questions
No. A high fever is rare at the onset. Suspicion is mainly based on a combination of symptoms: abdominal pain, often fixed in the lower right part of the abdomen, loss of appetite, fever, nausea, vomiting and worsening general condition.
Not necessarily. If the pain remains unchanged for several days and is not associated with other symptoms, it is less likely to be acute appendicitis. However, if the pain persists, worsens or is associated with fever, vomiting or malaise, medical assessment is important.
Yes. In boys and adolescents, in case of acute abdominal pain, testicular torsion should also be considered among the conditions that need to be ruled out quickly.
The pain is often located in the lower right part of the abdomen, known as the right iliac fossa. In some cases, it may begin more centrally or around the navel and then move.
When the child has a worsening general condition, significant or persistent pain, fever, vomiting, marked loss of appetite or appears weak and suffering.
Diagnosis starts with a medical examination. Depending on the clinical picture, an abdominal ultrasound and blood tests may be requested.
When the diagnosis of acute appendicitis is confirmed, the indicated treatment is appendicectomy, according to surgical assessment.
It may be performed using an open or laparoscopic technique. When indicated, the laparoscopic technique is recommended by Dr Rapuzzi.
In early cases, the hospital stay may last about 3 days. In cases of perforation or peritonitis, it may be extended up to 10–14 days, depending on clinical progress.
Note: the information on this website is provided for guidance only and does not replace a specialist medical assessment. In case of acute symptoms, significant pain or a worsening general condition, you should contact a doctor or go to the emergency department.
OTHER CONDITIONS
