Appendicitis

What is appendicitis?

Appendicitis is a painful swelling and infection of the appendix (a narrow, finger-like pouch that branches off the large intestine). Doctors are not really sure what the appendix does, but removing it is not harmful. Appendicitis is the most common cause of emergency surgery in childhood.

Appendicitis affects 1 in 1,000 people living in the U.S. Most cases of appendicitis occur between the ages of 10 and 30 years.

Since an infected appendix can rupture and be a life-threatening problem, call your health care provider or go to the emergency room immediately if your child has these symptoms:

  • sudden, pronounced pain around the belly button area
  • in a short period of time, the pain moves to the lower right-hand part of the abdomen and your child may have a difficult time breathing

What are the symptoms of appendicitis in children?

The following are the most common symptoms of appendicitis in kids. However, each child may experience symptoms differently. Symptoms may include:

  • 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, 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

A laparoscopic appendectomy for a patient with appendicitis.

What causes appendicitis in children?

Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, stool, or parasites. The appendix then becomes irritated and inflamed. The blood supply to the appendix is cut off as the swelling and irritation increase. Adequate blood flow is necessary for a body part to remain healthy. 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.

Why is appendicitis in children 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 very quickly and be difficult to treat if diagnosis is delayed.

How we care for appendicitis

Appendicitis can be an emergency situation. The Department of Surgery 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.

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.

Emergency medicine physicians and scientists at the Proteomics Center at Boston Children's have demonstrated that a protein detectable in urine might serve as a "biomarker" for appendicitis, potentially allowing diagnosis in a matter of minutes.