Appendectomies

About 70,000 children per year in the United States get appendicitis, which strikes slightly older children (10 years and above) more so than younger children. Appendicitis is the most common pediatric surgical emergency. In young children the condition can be difficult to diagnosis, but you can always trust WakeMed Physician Practices Pediatric Surgery to understand how to tailor the physical examination to the child's age and developmental stage to determine whether pediatric surgery is called for.

What is 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 people 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 intestine). 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, which can be deadly.

Most often, the 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-like being in a car wreck-can cause obstruction, but other sources of obstruction and infection include:

• Food waste or a hard piece of stool (called a fecal stone) 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-a potentially dangerous condition called peritonitis. If your child has pain that begins near the belly button and then moves lower and to the right, and it worsens quickly (in a matter of hours), seek pediatric medical care right away.

How does a surgeon do an appendectomy?
Typically, appendicitis is treated by surgery to remove the appendix. Two methods are used: the older method, called laparotomy, removes the appendix through a single incision in the lower right area of the abdomen, while the new method, called laparoscopic surgery, uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix.

Laparoscopic surgery, called a minimally invasive procedure, generally leads to fewer complications, and patients often have a shorter recovery time.