Appendicitis

Appendicitis is a condition in which the appendix becomes inflamed, causing painful swelling and infection. The classic symptoms are fever, nausea and vomiting, and abdominal pain, but those symptoms may not always be evident in children, which can make diagnosis difficult. Anyone can get appendicitis, but it is most common among children and young adults, ages 10 to 30.

The appendix is a small pouch, or sac, shaped liked a finger and located on the lower right side of the abdomen. It projects out from the colon (large intestines). Although its uses are not understood, it can cause painful problems when it becomes obstructed, and if it becomes infected, it can leak into the entire abdominal area, creating a life-threatening situation.

Most often, appendicitis occurs when mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply and the appendix to swell. Sometimes, blunt force trauma to the abdomen, such as trauma caused by a car wreck, can cause obstruction, but other sources of obstruction and infection include:

• Food waste or a hard piece of stool (called a fecalith) can become trapped in the appendix cavity.
• Parasites or growths can also cause a clog.
• Enlarged lymph tissue in the wall of the appendix, which can be caused by infection elsewhere in the body, like the gastrointestinal tract
• Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease

An inflamed appendix will likely burst if not removed. Bursting, also called a ruptured appendix, spreads infection throughout the abdomen, resulting in a dangerous condition called peritonitis that needs immediate medical attention.

Common Symptoms of Appendicitis:

• Persistent pain around the belly button or in the upper or lower abdomen that worsens and moves to the lower right abdomen. May be accompanied with nausea or vomiting.
• Loss of appetite
• Abdominal swelling
• Fever
• Constipation or diarrhea with gas (inability to pass gas)

Laparoscopic Appendectomy


The best way to effectively treat appendicitis is to remove the appendix. This is the most common emergency operation performed in children and is done hundreds of times each year by board-certified, highly trained pediatric surgeons at WakeMed. The best way to effectively treat appendicitis is to remove the appendix. This is the most common emergency operation performed in children and is done hundreds of times each year by board-certified, highly-trained pediatric surgeons at WakeMed. The surgeon will typically make several tiny incision in the lower abdomen for placement of the laparoscope and several small instruments. The laparoscope is connected to a digital video camera which allows the surgeon to see the appendix and surrounding organs. Occasionally, the surgeon will leave a drainage tube in to evacuate any infected fluid, but this drain will usually be removed prior to discharge from the hospital.

With early (acute) appendicitis that has not ruptured, most children may be discharged home in less than 24 hours following the procedure. If the appendix has ruptured, most children require hospitalization for intravenous (IV) antibiotics for four to seven days, depending on the severity of the infection.

Patients normally stay no more than one day in the hospital and recover quickly, usually within one to two weeks.

Pediatric Appendectomy


Laparoscopic appendectomy for the treatment of simple, acute appendicitis in children can offer a quicker return to full diet and shorter post-operative length of stay. This is due in part to improvements in the surgical procedure that reduce trauma and pain.

Learn What to Expect from Appendectomy

Read a journal article on laparoscopic appendectomy written by WakeMed's own


Duncan Phillip, MD, FACS, FAAP