The appendix is ​​located in the lower right part of the abdomen, and it is a small part of the intestine. Appendicitis is a common problem in children, but it remains an emergency that requires immediate medical care, and it may require an urgent operation to remove the appendix. What are the causes of appendicitis in children? And can this inflammation be prevented? Continue reading the article in Dalili Medical for more information.

What is appendicitis in children?

 

Appendicitis is an infection of the appendix, a small finger-like organ connected to the large intestine, and it has no clear function in the body, as the child can live a normal life without it. Appendicitis is a serious, life-threatening medical condition, and may occur as a result of a blockage resulting from hard stool containing bacteria, or due to enlarged lymph nodes in the intestine, or as a result of inflammation of the intestine and colon. In rare cases, it may be associated with swallowing foreign objects, or infection with certain types of worms, tumors, or cystic fibrosis.

How long do the symptoms of appendicitis last in children?

 

Appendicitis pain usually gets worse over time, with symptoms becoming more severe within 24-36 hours of its onset. If medical intervention is not provided within this period, the appendix may burst, causing a high fever and worsening symptoms, with abdominal pain becoming very severe.

**Who is most at risk for appendicitis?**

 

Appendicitis is common in children and adolescents between the ages of 5 and 20, while it rarely affects infants.

**What causes appendicitis in children?**

 

Before performing an appendectomy for children, it is important to know the causes that lead to its occurrence.

Appendicitis occurs as a result of a blockage in the appendix cavity. The appendix has a narrow cavity that can easily be blocked by stool, mucus, parasites, or enlarged lymph nodes, as this accumulation acts as a suitable environment for the growth of bacteria.

The resulting infection causes the appendix to swell and collect mucus. In some cases, excess mucus can cause the appendix to burst, causing the infectious contents to leak into the abdominal cavity.

This leakage can cause inflammation of the inner lining of the abdomen known as the peritoneum. The blood supply to the appendix can also be interrupted, leading to cell death and necrosis of the appendix, which is a serious and life-threatening condition.

When do symptoms of appendicitis start in children?

 

Appendicitis can affect anyone, but children between the ages of six and ten are most likely to develop this disease.

What causes appendicitis?

The inflammation usually occurs as a result of the entrance of the appendix being blocked by food waste left in the intestine. Sometimes, parasitic worms or foreign bodies may be responsible for this blockage. When the blockage worsens due to the proliferation of bacteria, the appendix becomes swollen, inflamed, and filled with pus, leading to the clinical symptoms associated with appendicitis.

**What are the symptoms of appendicitis in children?**

 

The signs and symptoms of appendicitis in children vary and may vary from case to case, but the clinical symptoms resulting from this inflammation are not always typical.

Common symptoms and signs that may indicate appendicitis in children include:

**Severe abdominal pain:** The location of the pain may vary, as the child may feel pain around the navel, above the stomach, or in the middle of the abdomen, and then the pain moves to the lower right side of the abdomen after feeling the initial pain. The pain also gets worse with coughing or movement, and worsens within a few hours.

It is important to note that the anatomical position of the appendix can vary from one child to another, which affects the location of the pain. For example, if the appendix is ​​located behind the cecum, the child may feel pain in the back or side. If the appendix is ​​in the pelvic area, it may cause pain in the suprapubic area.

**Digestive system symptoms:** include nausea, vomiting, and loss of appetite, and these symptoms often appear after the onset of abdominal pain.

**High body temperature:** In the case of appendicitis, the body temperature may rise slightly, ranging between 37.7 and 38.3 degrees Celsius.

**Pain on pressure:** The child may feel pain when pressure is applied to the lower right side of the abdomen, especially at McBurney’s point. These signs are among the most common signs that indicate appendicitis, as pain can be felt in the lower right abdomen when pressure is applied to the lower left side, which is known as Rovsing’s sign.

**Psoas sign:** This sign shows an increase in pain in the lower right side of the abdomen when the patient is lying on his left side, while the doctor extends the patient’s right leg out of the pelvis.

**Obturator sign:** This sign indicates an increase in pain resulting from appendicitis in the lower right side of the abdomen, when the doctor bends the patient’s thigh and brings it toward the body.

Tests that are usually performed include the following:

1. **Complete blood test**: This test is used to check for any signs of infection.

2. **Urine tests**: These tests are done to rule out urinary tract infections or kidney stones as possible causes of the symptoms, where a urine sample is collected in the laboratory.

3. **Pregnancy test**: Ectopic pregnancy can be confused with appendicitis, where the fertilized egg implantsIn the fallopian tube instead of the uterus.

4. **Pelvic exam**: Symptoms can be caused by pelvic inflammatory disease, polycystic ovary syndrome, or other conditions affecting the female reproductive organs.

5. **Abdominal imaging tests**: These tests are used to check for appendicitis, and include abdominal ultrasound, X-rays, and MRI.

**Diagnosing appendicitis in children**

Children often have abdominal pain, followed by symptoms such as nausea, vomiting, and fever.

**Measuring vital signs**

**Physical exam**: The pain is usually in the lower right part of the abdomen, and the abdominal muscles may feel tight when pressed. However, a physical exam can be difficult to perform in young children, as they are often fearful and resistant to the exam, which can affect the accuracy of the results.

Blood tests usually reveal an elevated white blood cell count.

Urine tests are often normal.

**McBurney’s sign** This is the most common sign associated with appendicitis, where pain occurs at McBurney’s point, which is located in the middle third of the line between the umbilicus and the anterior superior iliac spine on the right side of the abdomen.

**Blumberg’s sign** Also known as the rebound pain sign, where the doctor applies pressure to the abdomen and then quickly releases the pressure, which increases the feeling of pain.

**Dunphy’s sign**

Coughing worsens the abdominal pain.

**Rovsing’s sign** When pressure is applied to the lower left side of the abdomen, pain occurs in the lower right side, as a result of gases rushing through the transverse colon, which leads to the expansion of the cecum and movement of the inflamed appendix, which causes irritation of the peritoneum and pain.

**Psoas sign**The child is placed in a supine position on the left side, and the examiner extends the right thigh, stretching the psoas muscle. If there is pain, the psoas sign is positive, indicating possible appendicitis.

**- Laboratory diagnosis**An elevated white blood cell count and C-reactive protein level are seen. A urine test is also performed because the symptoms of appendicitis are similar to those of a urinary tract infection.

**- Radiological diagnosis**An abdominal ultrasound is performed, and CT or MRI may also be used.

**Types of appendectomy**

This surgery is known as appendectomy, and it is a surgical procedure that can be performed either through open surgery or laparoscopically. The patient is generally anesthetized in both types of surgery.

The choice of type of surgery depends on several factors, such as the severity of the appendicitis and the patient's medical history. Here are details on how each type of appendectomy is performed:

**Open appendectomy**The doctor makes a small incision in the lower right part of the abdomen, then cuts and removes the appendix, and closes the incision with sutures. Open surgery is preferred if the appendix has ruptured and the infection has spread to nearby organs.

**Laparoscopic appendectomy**The doctor uses a laparoscope to insert it into the abdomen through a small incision. The tip of the laparoscope contains a small video camera that allows the doctor to see inside the abdomen on an external screen. The doctor makes two more small incisions to insert special tools to cut and remove the appendix. Laparoscopic appendectomy is the best option for older adults and people with certain health conditions.

**First aid for appendicitis**

Appendicitis is a medical condition that requires urgent surgery to avoid the risk of the appendix bursting or rupturing. However, some measures can be taken to relieve the patient's suffering until the diagnosis is made and the necessary operation is performed to remove it:

- Providing intravenous fluids (solutions) to the patient to avoid dehydration resulting from vomiting or diarrhea.

- Monitoring the patient's vital signs every two to four hours.

- Avoid using any heat source over the area of ​​pain while waiting for the diagnosis, as this may increase the risk of appendicitis rupture.

- Refraining from giving the patient painkillers before the examination, as this may affect the accuracy of the diagnosis.

- After confirming the diagnosis, the patient can be given some painkillers intravenously to relieve pain until the surgery is scheduled.

**Foods that help prevent appendicitis**

Diets rich in dietary fiber are effective in reducing the likelihood of developing appendicitis. Foods that are high in fiber include:

- Berries

- Apples

- Pears

- Artichokes

- Peas

- Broccoli

- Lentils

- Green beans

- Bran flakes

- Barley

- Oats

- Whole grains

**Treatment of appendicitis in children**

Treatment of appendicitis in children usually requires surgery, although non-surgical options may be considered in some special cases.

**Surgical treatment**Appendectomy:** Surgical removal of the appendix is ​​the primary treatment for appendicitis. This can be done through open surgery or using a laparoscope, as the latter method is less invasive and provides faster recovery periods.

**Non-surgical treatment**Antibiotic treatment:** In some cases, especially when surgery is risky, antibiotics can be used to treat uncomplicated appendicitis. However, this approach requires close monitoring and may not be suitable for all patients.

**Treatment of appendicitis with herbs**There are two types of appendicitisBloody: Acute appendicitis and chronic appendicitis.

**Acute appendicitis** Acute appendicitis is an emergency condition that occurs suddenly, where the patient may feel sudden pain that gets worse quickly within 24 hours. This type of inflammation requires urgent surgical intervention, as neglecting it may lead to serious complications.

**Chronic appendicitis** Chronic appendicitis is less common compared to acute appendicitis, as symptoms are usually relatively mild. It is believed that this type of inflammation often occurs after an episode of acute appendicitis.

Symptoms may disappear for periods before reappearing again, and this cycle may continue for weeks, months, or even years.

Diagnosing chronic appendicitis can be challenging, as doctors may not be able to identify it until it develops into acute appendicitis.

**Treatment of appendicitis with herbs**

Here are some natural ways to treat appendicitis with herbs:

. **Fenugreek seeds**   Fenugreek seeds drink helps prevent stool from accumulating in the appendix, and also helps reduce mucus and pus, which relieves pain. 

Boil two tablespoons of fenugreek seeds in a liter of water for 30 minutes. 

After that, the drink is filtered and taken twice daily to treat appendicitis.

. **Ginseng**   Ginseng herbs have anti-inflammatory properties, and are known for their effectiveness in relieving appendicitis pain. 

It is recommended to drink ginseng tea twice daily to relieve pain and achieve a feeling of comfort.

**. Mint**

Mint tea helps relieve symptoms of appendicitis, such as nausea, vomiting, and gas.

Mint tea can be prepared by boiling the leaves in water, and it is recommended to drink it three times daily.

It is also preferable to chew some mint leaves to relieve appendicitis pain.

**. Holy Basil**Holy basil is also known as the “Tulsi plant”, and helps relieve symptoms and reduce fever associated with appendicitis.

Basil tea can be prepared by boiling the leaves in water, and it is recommended to drink it twice daily.

**. Ginger**Ginger has anti-inflammatory properties, which helps relieve inflammation and other symptoms such as nausea, vomiting and pain.

Turmeric can be taken twice daily to relieve symptoms.

**. Turmeric**Turmeric contains the active compound curcumin, which has anti-inflammatory properties, and is known for its medicinal benefits in relieving pain, treating inflammation and nausea.

You can add half a teaspoon of turmeric to a cup of water with half a teaspoon of ginger, then boil the mixture well and drink it twice daily.

**How ​​is appendicitis removed in children?**

 

Before the appendectomy, the child receives antibiotics and painkillers. Once his condition stabilizes, he undergoes the surgery, which is performed under general anesthesia and takes about an hour.

The appendix is ​​removed using one of the following two procedures:

. **Laparoscopic**: The pediatric surgeon makes several small incisions in the lower abdomen on the right side, and inserts a laparoscope and small surgical tools through these incisions to remove the appendix. This surgery is characterized by a quick recovery and a low risk of complications after the operation.

. **Open surgery**: A single large incision is made in the lower abdomen on the right side. The pediatric surgeon resorts to this type of surgery in certain cases that require it.

When can a child go home after an appendectomy?

 

The length of the child's stay in the hospital after the operation depends on his health condition before the surgery and the timing of the diagnosis of appendicitis.

If the appendicitis is treated urgently and removed quickly, the child may be able to go home on the same day.

In cases where the appendix ruptures, the child may need to stay in the hospital for several days after the surgery, as the doctor monitors his condition and gives him antibiotics to reduce the risk of infection. The child can leave the hospital when his condition stabilizes and his bowel function returns to normal.

Can appendicitis be prevented in children?

 

Appendicitis in children is of unknown cause, and it may occur as a result of obstruction of the appendix due to the entry of hard stool or some parasites. Therefore, there are no specific ways that we can follow to prevent our children from getting this inflammation.

**The most important tips after appendectomy for children**

1. **Open appendectomy:**

- Strenuous activities such as cycling, gymnastics, contact sports, martial arts, or going to the school gym, in addition to lifting weights, should be avoided until the surgeon is consulted at the follow-up appointment.

2. **Laparoscopic appendectomy:**

- The child can resume daily activities normally and without restrictions, according to what is allowed.

3. **Diet:**

- Your child can eat and drink as usual.

- If vomiting occurs, he should not be given any food or drink for two hours. After that, small amounts of clear fluids or diluted juice can be given until he stops vomiting. Your child can then gradually return to his normal diet. 

- If vomiting persists, it is advisable to contact the doctor.

4. **Pain:**

- Your child can take acetaminophen or ibuprofen to relieve discomfort if the pain is mild.

What are the complications of appendicitis in children?

 

1- Ischemia and necrosis Severe edema in the inflamed appendix reduces blood flow to it, which worsens the inflammation and eventually leads to necrosis.

2- Death or perforation When necrosis begins, infection can spread. This may happen slowly through internal death (Gangrene) or quickly through rupture or explosion of the appendix (perforation). The incidence of perforation depends on the age of the child, reaching 65% in children under the age of five, and 90% in children under the age of two.

3- Abscess or phlegmon At first, the infection may not spread far from the appendix, but an abscess can form in the outer part of it. The condition can also develop into a mass around the inflamed appendix known as phlegmon, which contains pus, and may burst, leading to the spread of infection.

4- Peritonitis When the infection spreads to the abdominal cavity, peritonitis occurs, which leads to the infection spreading to the blood, thus causing sepsis, which may cause septic shock.