Appendicitis in Children

What is appendicitis and in whom does it occur?

Acute appendicitis is the most common childhood disease requiring emergency surgery. Appendicitis is an inflammatory disease of the appendix, which is a part of the large intestine and develops as a blind protrusion. Although it is most common in children between the ages of 10 and 14, it may have a more severe course in younger children due to late diagnosis. It is more common in boys than girls.

What does the appendix do?

In the past, appendicitis was believed to be a dysfunctional and unnecessary organ, and the patient was even for another reason. If there was an operation, the patient's appendix would be removed with the same operation. However, studies have shown that there are many immune cells (lymphoid tissue) in the appendix wall and that this organ is an important part of the immune system. Although symptoms similar to acute appendicitis may be seen in case of swelling of the lymphoid tissue in the appendix wall at any time of infection, surgery may not be needed when the condition does not progress to acute appendicitis. However, if acute appendicitis has developed, surgical removal of the appendix is ​​required at this time. It is thought that this situation will not cause serious side effects in the lives of children later on.

How does appendicitis develop?

Since the appendix is ​​an organ with a blind ending, after any event that causes obstruction of the entrance, the discharge of the secreted mucus can be prevented. In this case, the increasing fluid in the appendix causes the appendix to swell and gradually disrupt the blood circulation. Impairment of blood flow causes swelling and inflammation of the appendix wall. Although stool stones are the most common cause of obstruction of the entrance of the appendix, foods such as small sized kernels and sunflower seed shells can also cause. Apart from this, since there are many immune cells (lymphoid tissue) in the appendix wall, these lymph cells may swell and cause obstruction after other organ infections such as intestine or throat, lung.

   In the first stage when inflammation develops, the infection is limited to the appendix (acute appendicitis9. However, if the appendix is ​​not diagnosed and treated in time, The s wall thins and bursts (perforated appendicitis), the infection and the stool inside the appendix spread into the abdomen. In the case of perforated appendicitis, the treatment of the disease becomes difficult, and in very advanced cases, it can cause life-threatening conditions (septic shock).

What are the symptoms?

   The most important symptom of appendicitis is abdominal pain. It typically starts mildly in the front and around the navel, intensifies within 24 hours and settles in the right middle-lower part of the abdomen. Although this history is easy to take in older children, younger children may not fully understand the location of the pain and express their complaints clearly. For this reason, children under 5 years of age are diagnosed with appendicitis later and the risk of developing ruptured appendicitis is higher.

   In addition, the following symptoms are seen in children with appendicitis:

• Anorexia (one of the most important findings)

• Nausea and vomiting (starts after pain)

• Diarrhea

• Fever (More common in perforated appendicitis)

• Walking with a bent to the right

• Lying silently and with feet on the abdomen

Plansed appendix After the infection progresses, children become more sluggish and sluggish. Non-reducing fever, recurrent vomiting and diarrhea can also be seen frequently in this condition.

How is the diagnosis made?

   diagnosis of appendicitis requires taking a detailed history. starts. How the pain started and continued, appetite status, which additional symptoms, and the child's known disease history are questioned in detail. A physical examination is then performed. The most important criterion in the diagnosis of appendicitis is the physical examination performed by the Pediatric Surgeon. The diagnosis can be made by physical examination and the decision for surgery can be made. Apart from this, the condition of the child is learned in detail by performing auxiliary blood tests. USG (ultrasonography) is also used in diagnosis. In cases where other pathologies are not suspected in the diagnosis of acute appendicitis in a child, imaging such as computed tomography is not required.

What other diseases can appendicitis be confused with?

Acute appendicitis in children can be confused with some diseases with similar symptoms.

• Gastroenteritis

• Constipation

• Urinary tract infection

• Ovarian cysts in girls

• Inflammatory bowel diseases

• Intestinal knots (invagination)

How is appendicitis treated?

The treatment of appendicitis is surgical removal of the organ – appendectomy.

  If the appendix has not ruptured beforehand, the patients are discharged home the next day. In cases of ruptured appendicitis, patients continue to stay in the hospital for 3 to 7 days, depending on the situation, in order to receive intravenous antibiotics. On average, it is 1 – 2 weeks, with total recovery time after hospitalization.

What happens if surgery is not done?

If appendicitis is not diagnosed or treated, perforated appendicitis develops and Then the infection spreads into the abdomen. Infection that spreads into the abdomen results in peritonitis, which can subsequently lead to a disseminated infection, such as life-threatening septic shock, if the patient is still untreated.

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