Diagnosing Appendicitis: Signs and Symptoms | St. Louis Children's Hospital
Appendicitis in Children: Signs, Symptoms, and More
The signs and symptoms of appendicitis, as well as the treatment, can be different in children than in adults.
A stomachache is a very common occurrence, especially in children. While abdominal pain accounts for about 9 percent of childhood visits to primary care offices, according to a report published in May 2019 inAmerican Family Physician,(1) the abdominal pain your child experiences is usually the result of something non-life-threatening, (2) such as:
If your child's stomachache intensifies or lasts for more than a day, it could be a sign of a serious condition. But again, there's a long list of diseases that could cause this abdominal pain, including:
But if your child's pain begins in the belly-button area and spreads to the lower right abdominal area, it may be the result of appendicitis, a medical condition in which the appendix — a small, finger-shaped pouch attached to the large intestine in the lower right belly area — becomes inflamed. In children who’ve gotten emergency medical care for acute abdominal pain, about 10 to 30 percent have had appendicitis or another condition requiring surgical intervention. (1)
Appendicitis most often affects teens and those in their twenties, but it can occur in children as well. According to the Cleveland Clinic, approximately 80,000 children in the United States are affected each year. (3) It's usually caused by an abdominal infection that has spread to the appendix, or by a blockage that has obstructed the appendix.
If your child's abdominal pain worsens with movement, deep breaths, coughing, or sneezing, the possibility that he or she has appendicitis should be seriously considered.
Still, it's important to look for other signs of appendicitis.
The Signs and Symptoms of Appendicitis in Children
In most adults, there is a very specific set of appendicitis symptoms that accompany abdominal pain. These often include:
But research suggests that appendicitis can affect children differently than adults. Along with abdominal pain, most kids with appendicitis often experience fever and a symptom known as "rebound tenderness," (1) a sharp pain that develops after pressure is placed on the lower right abdominal area and quickly released. Children may also have an elevated white blood cell count, which is a sign of an infection. Your doctor can check this with a blood test. (4)
Importantly, although some kids with appendicitis do experience other hallmark symptoms of the condition, including nausea, vomiting, and lack of appetite, these signs are not predictive of appendicitis in children, according to a study published in July 2007 in theJournal of the American Medical Association. (5)
More on Symptoms of Appendicitis
Appendicitis may also cause different sets of symptoms with very young children. Some studies suggest that kids between ages 2 and 5 most often experience stomachaches and vomiting if they have appendicitis; fever and loss of appetite also frequently occur.
For infants younger than 2 years old, appendicitis usually causes vomiting, a bloated or swollen abdomen, and fever, though diarrhea is also not uncommon. (6)
To confirm a diagnosis of appendicitis, doctors often use imaging procedures. For children, the American College of Radiology recommends performing an ultrasound first, followed by a computed tomography (CT) scan only if the ultrasound is inconclusive. This is due to caution concerning radiation exposure in kids. (7)
Treating Complicated and Uncomplicated Appendicitis in Children
An appendectomy, which involves the surgical removal of the appendix, is the standard treatment for appendicitis in children as well as adults. If appendicitis isn't caught in its early stages, the appendix can rupture and cause an infection of the peritoneum, the membrane that lines the abdominal cavity. This infection, called peritonitis, can quickly spread, potentially causing death.
Because appendicitis is more difficult to diagnose in children than adults — especially in children younger than 5 — some 30 percent of kids with the condition will suffer from a perforated (ruptured) appendix before being treated. (3) (Some data suggests that in children younger than five, it may be up to 51 percent). (8)
For kids with acute, nonperforated appendicitis (meaning the appendix hasn’t ruptured), an urgent appendectomy is the accepted, optimal treatment. When the appendix has ruptured, though, there are two surgical courses of action: early appendectomy (performed within 24 hours of admission) or interval appendectomy (performed several weeks later) after antibiotics are used to treat infection.
As a study published in October 2019 inPediatrics and Neonatologynotes, there hasn’t been a clear consensus on which is the best way to manage ruptured appendices in children — with conservative treatment (antibiotics followed by interval appendectomy) or early appendectomy. (9)
Traditionally, the conservative treatment has been preferred, but other research, including a studypublished in the journalJAMA Surgery, suggested that kids recover more quickly and are less likely to suffer from post-surgery complications, such as surgical site infections, if their ruptured appendices are removed within 24 hours of diagnosis. (10)
Researchers conducting the 2019Pediatrics and Neonatologystudy found that such patients may benefit from early appendectomy, as it could shorten the duration of antibiotics, reduce the need to increase antibiotics, and decrease the length of hospitalization. They note that more research is needed to confirm their findings. (9)
When acute appendicitis is uncomplicated and the appendix hasn’t ruptured, there’s increasing evidence supporting antibiotics as an alternative to surgery in adults, and recent studies have also examined if this holds true in pediatric cases. A meta-analysis of studies published in March 2019 inPediatricsfound that data suggests nonoperative treatment is safe and effective in children with acute uncomplicated appendicitis. (11)
Again, study authors say more research is needed. Clinical trials investigating appendectomy versus nonoperative treatment in children whose appendices are not ruptured are currently underway in the United States and the United Kingdom.
Video: Appendicitis - Rob Weinsheimer, M.D.
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