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Appendicitis

  • Appendicitis is an irritation, inflammation and infection of the appendix (a narrow, hollow tube that branches off the large intestine).

    • The appendix functions as part of the immune system during the first few years of life.
    • After this time period, the appendix stops functioning and other organs take over the job of fighting infection.
    • Appendicitis is the most common cause of emergency surgery in childhood.

    Appendicitis 

    Since an infected appendix can rupture and be a life-threatening problem, please call your physician immediately if you think your child has appendicitis.

    A comprehensive level of care

    Appendicitis can be an emergency situation. The General Surgery Program at Boston Children's Hospital has surgeons ready day and night to diagnose appendicitis and then remove your child's appendix, either before or after it has ruptured.

    A new test to diagnose appendicitis

    Appendicitis is the most common childhood surgical emergency, but the diagnosis can be challenging, especially in children, often leading to either unnecessary surgery in children without appendicitis, or a ruptured appendix and serious complications when the condition is missed.

    Now, emergency medicine physicians and scientists at the Proteomics Center at Boston Children's Hospital demonstrate that a protein detectable in urine might serve as a "biomarker" for appendicitis.

    Contact Us

    Appendicitis can be an emergency situation. The General Surgery Program at Children's has surgeons ready day and night to diagnose appendicitis and then remove your child's appendix, either before or after it has ruptured.

    Boston Children's Hospital
    300 Longwood Ave
    Boston MA 02115

     617-355-7800

  • What causes appendicitis?

    Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, stool or parasites.

    Then, a series of events happens.

    • The appendix becomes irritated and inflamed.

    • The blood supply to the appendix is cut off as the swelling and irritation increase.

    • When the blood flow is reduced, the appendix starts to die.

    • Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen.

    • An infection inside the abdomen known as peritonitis occurs when the appendix perforates.

    How often does appendicitis occur?

    Most cases of appendicitis occur when a child/young adult is between the ages of 6 and 20.

    • It is uncommon in children under four years, but the rate of perforation is high in this group since young children are unable to tell exactly how they feel and "where it hurts."

    • Appendicitis occurs in equal numbers in boys and girls.

    • About four appendectomies (surgical removal of the appendix) are done in every 1000 children under age 14.

    Why is appendicitis a concern?

    An irritated appendix can rapidly turn into an infected and ruptured appendix, sometimes within hours. A ruptured appendix can be life threatening. When the appendix ruptures, bacteria infect the organs inside the abdominal cavity, causing peritonitis. The bacterial infection can spread quickly and be difficult to treat.

    What are the symptoms of appendicitis?

    Each child may experience symptoms differently, but here's a list of the most common symptoms:

    • pain in the abdomen which:
      • may start in the area around the belly button, and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen.

      • usually increases in severity as time passes.

      • may be worse with moving, taking deep breaths, being touched and coughing or sneezing.

      • may spread throughout the abdomen if the appendix ruptures.

    • nausea and vomiting
    • loss of appetite
    • fever and chills
    • changes in behavior
    • diarrhea or constipation

    Symptoms of appendicitis may resemble other conditions or medical problems. Consult your physician for a diagnosis.

  • How is appendicitis diagnosed?

    In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include:

    • Abdominal ultrasound - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

    • Computerized tomography scan of the abdomen (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. (CT scans are more detailed than general x-rays.)

    • Blood tests- to evaluate the infection, or to determine if there are any problems with other abdominal organs, such as the liver or pancreas.

    • Urinalysis- to detect a bladder or kidney infection, which may have some of the same symptoms as appendicitis. A protein detectable in urine might serve as a "biomarker" for appendicitis.

  • Because of the likelihood of your child's appendix rupturing and causing a severe, life-threatening infection, physicians will recommend that the appendix be removed with an operation.

    The appendix may be removed in two ways:

    • Open method - under anesthesia, an incision is made in the lower right-hand side of your child's abdomen. The surgeon finds the appendix and removes it. If the appendix has ruptured, a small drainage tube may be placed to allow pus and other fluids that are in the abdomen to drain out. The tube will be removed in a few days, when the surgeon feels the abdominal infection has subsided.

    • Laparoscopic method - This procedure uses several small incisions and a camera called a laparoscope to look inside your child's abdomen during the operation. While your child is under anesthesia, the instruments the surgeon uses to remove the appendix are placed through several small incisions, and the laparoscope is placed through another incision. This method is not usually performed if the appendix has ruptured.

    After surgery, your child will not be allowed to eat or drink anything for a specified period of time so the intestine can heal.

    • Fluids are given into the bloodstream through small plastic tubes called IVs until your child is allowed to begin drinking liquids.

    • Your child will also receive antibiotics and medications through the IV to help him/her feel comfortable.

    • Eventually, your child will be allowed to drink clear liquids (such as water, sports drinks or apple juice), and then gradually advance to solid foods.

    A child whose appendix ruptured will have to stay in the hospital longer than a child whose appendix was removed before it ruptured.

    What happens after my child leaves the hospital?

    Your physician will generally recommend that your child not do any heavy lifting, play contact sports, or "rough-house" for several weeks after the operation.

    • If a drain is still in place when your child goes home, she should not take a tub bath or go swimming until the drain is removed.

    • Your child may need to take antibiotics at home to help fight the infection in the abdomen.

    • You will be given a prescription for pain medication for your child to take at home to help her feel comfortable. Some pain medications can make your child constipated, so ask your physician or pharmacist about any side effects the medication might have.

    • Moving around after surgery rather than lying in bed can help prevent constipation.

    • Drinking fruit juices and eating fruits, whole grain cereals and breads and vegetables after being advanced to solid foods can help with constipation as well.

  • Appendicitis can be tricky to diagnose in children. Even with improved radiologic imaging, many children undergo unnecessary surgery, while others are only diagnosed after their appendix has already burst. Now, teaming up with Hanno Steen, PhD, director of Boston Children's Hospital's Proteomics Center, emergency physicians Richard Bachur, MD, and Alex Kentsis, MD, PhD, have identified a "biomarker" for appendicitis that can be picked up with a urine test, potentially allowing diagnosis in a matter of minutes.

    Laboratory biomarkers for appendicitis have been found in the past, but none have proved reliable enough to be clinically useful. "Recent diagnostic advances have focused on advanced radiologic procedures, such as computed tomography and ultrasound, but these can delay diagnosis and aren't universally available," says Bachur, acting chief of Emergency Medicine. "CT scans also expose children to radiation that may increase their risk of cancer."

    The team took urine samples from 67 children with possible appendicitis, 25 of whom had proven cases. They then used mass spectrometry, a technique that detects and quantifies proteins in a sample, to test for 57 potential markers. One, leucine-rich alpha-2-glycoprotein (LRG), emerged as the best of the group, detecting or ruling out appendicitis with few false positives or negatives.

    Bachur and Kentsis now plan to validate their findings using clinically available tests. Steen predicts that proteomics will provide diagnostic markers for many more pediatric diseases in the future. The report was published online June 23 by the Annals of Emergency Medicine.

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