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Inflammation (a cellular response to injury or blockage) of the appendix (a tube of tissue that extends from a portion of the large intestine, usually along the lower right-hand side of the abdomen) can cause abdominal pain and is considered a medical emergency. Although it can strike at any age, appendicitis is rare under 2 years of age and most commonly occurs between the ages of 10 and 30 years. The appendix has no apparent function, but if an inflamed appendix is not treated, it can rupture and release its contents into the surrounding abdominal cavity. This can cause peritonitis (painful inflammation of the lining of the intestines and abdominal cavity). The July 25, 2007, issue of JAMA includes an article that discusses the clinical features of children with this potentially life-threatening condition.
Dull pain near the navel or upper abdomen that becomes sharp as it moves to the lower right abdominal area
Loss of appetite
Vomiting after the onset of abdominal pain
Inability to walk normally because of pain, or pain when asked to cough or jump
Constipation (inability to pass feces) or diarrhea
Diagnosis can be difficult since the symptoms can be similar to other ailments. Because of the threat of rupture, appendicitis is considered an emergency. If your child has these symptoms, you should seek immediate medical attention. Do not allow your child to eat, drink, or use any medications before the evaluation.
The following tests are helpful in making the diagnosis:
Complete physical examination, including abdominal and pelvic examinations
Urine test to exclude a urinary tract infection
Blood tests to identify an infectious process
Diagnostic imaging tests, such as CT scans (x-ray tests) and ultrasound (using sound waves)
If appendicitis is suspected, appendectomy (surgical removal of the appendix) is the treatment of choice. Antibiotics are given prior to surgery, general anesthesia is used, and the appendix is removed through a single incision or by laparoscopy (removal of the organ through a scope). If the appendix has not ruptured, recovery is usually quick, and children usually leave the hospital 1 or 2 days after surgery. Most children can usually return to normal activities in 2 to 3 weeks. If rupture occurs, the recovery process can be more complicated.
For more information
American College of Surgeons (ACS) http://www.facs.org
American College of Gastroenterology (ACG) http://www.acg.gi.org
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A related Patient Page on acute abdominal pain was published in the September 27, 2006, issue.
Sources: American College of Gastroenterology, American Academy of Family Physicians, American College of Surgeons
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.
TOPIC: INTESTINAL DISEASE
Zeller JL, Burke AE, Glass RM. Acute Appendicitis in Children. JAMA. 2007;298(4):482. doi:10.1001/jama.298.4.482
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