New Approaches for Appendicitis in Children

Appendicitis is defined as inflammation of the appendix, which is a small section of the intestine that sticks out where the small and large intestines come together (similar to a dead-end side street in the intestines).

Appendicitis happens when the appendix gets blocked with a particle in the stool and then becomes inflamed. The blockage can cause bacteria to overgrow in the appendix, leading to infection and inflammation. Appendicitis is a common condition in childhood and typically occurs after age 10 years, although it can occur at any age. Appendicitis is the most common disease leading to surgery in children.

Children with appendicitis usually have abdominal pain that may begin in the middle of the abdomen and later become most painful in the lower right areas of the abdomen, where the appendix is located. They often have a fever, as well as vomiting, nausea, and loss of appetite. Compared with viral illnesses that can also include these symptoms, appendicitis symptoms typically get worse over time to the point in which a child may refuse to eat or avoid moving because of the abdominal pain. If you are concerned about appendicitis, call your pediatrician.

New research and clinical updates have led to changes in how appendicitis is diagnosed and treated. In the past, appendicitis was commonly diagnosed with a computed tomography scan. However, it is now common to use ultrasonography to help with diagnosing. This approach can help avoid the radiation and risks that are associated with computed tomography scans. For more information about radiation risks for kids, see the Advice for Patients article “Decreasing Unnecessary Radiation Exposure for Children” (http://jamanetwork.com/journals/jamapediatrics/fullarticle/384539).

Further, a diagnosis of appendicitis used to mean that surgery was almost guaranteed, but now additional treatment options may be possible. Instead of surgery using an “open appendectomy,” in which a surgeon removes the appendix through an incision in the abdomen, the more common approach for surgery is laparoscopic, which allows surgeries to take place using instruments that are inserted through tiny incisions. Laparoscopic approaches typically have a lower risk of infections and complications, as well as better pain control after the surgery and faster recovery.

Another change in the treatment of appendicitis is the involvement of antibiotics. Because appendicitis is typically associated with bacteria trapped in the blocked appendix, some physicians use antibiotics either before, or instead of, surgery to treat appendicitis. In some cases, such as perforated appendicitis, treatment can involve an “interval appendectomy.” This treatment involves an initial antibiotic treatment and then a return for an appendectomy. Nonoperative treatment for appendectomy has been shown to be as effective as surgery in up to 90% of children.

Published Online: September 5, 2017. doi:10.1001/jamapediatrics.2017.2935

Conflict of Interest Disclosures: None reported.