Shreya, an 8-year-old girl, began complaining about stomach ache one morning. As Shreya did not like online classes, Shreya’s mother thought her daughter was making excuses and ignored the complaint. When Shreya began crying due to intense pain, her mother thought it could be a case of indigestion and she resorted to home remedies to treat it. As the Covid cases were increasing during that time, her mother was hesitant to take the child to the hospital.  But the pain increased even more the next day and Shreya began vomiting and she even developed slight fever. Concerned about her daughter’s condition, she immediately fixed an online appointment with us.

During the online consultation, Shreya’s mother informed us about the stomach ache and vomiting. As kids mostly complain about these symptoms, we asked the mother to press Shreya’s abdomen at some points and observe the way she responds to it. After a careful inspection, when she pressed the lower abdomen of the child, Shreya began to experience severe pain and the doctor had a strong feeling that the pain was due to appendicitis. Upon our advice, the child was immediately brought to the hospital where we performed surgery on time and removed her appendix. It certainly was a brave act by Shreya’s mother to be attentive and careful at the same time and it was because of her mindfulness that we were able to detect the problem on time and treat it successfully.

In most incidents, the initial symptoms of appendicitis such as stomach ache, fever and loss of appetite are usually confused with other ailments. Also, in most of the cases, parents may not take such complaints from their kids seriously, as this keeps happening frequently. Therefore, diagnosing appendicitis in children may become difficult.

Appendicitis starts as a pain around the child’s bellybutton and spreads to other parts of the abdomen especially the right lower area. This occurs when the inside of the appendix is blocked by something, leading to an infection. The blockage can happen due to stool, parasites or a twist in the appendix as well. The appendix then gets sore and inflamed. and bacteria in the appendix begin to increase quickly. As the soreness and swelling gets worse, the blood supply to the appendix is cut off.

Symptoms of Appendicitis in Children

Each child may experience different symptoms. Below are few common symptoms of appendicitis:

• Loss of appetite
• Fever
• Vomiting
• Nausea
• Elevated white blood cell count
• Difficulty in passing gas or stool
• Abdominal swelling
• Constipation or diarrhea

Appendicitis can occur at any age although most commonly seen in children in the age group of 8 to 16 years. In younger children the symptoms may be a little nonspecific and it is important to maintain a high index of suspicion to make an early diagnosis.

If a kid experiences noticeable tummy pain when moving, coughing, sneezing, or touching the abdomen, it is important for the parents to immediately consult the doctor. For babies younger than 2 years of age, appendicitis can lead to vomiting, a bloated abdomen, and fever, though diarrhea is not very uncommon.

Is appendicitis serious?

Appendicitis is a serious medical condition that needs to be assessed, investigated and managed appropriately to avoid complications such as a perforated appendix or collection of pus.

When should you consider stomach ache seriously among kids?

In case your kid experiences any of the following signs along with stomach ache, make sure to schedule an appointment with the doctor to understand the cause of pain your child is going through.

• Recurrent stomach pain with no clear cause
• Blood in stool
• Constipation that is becoming frequent
• Diarrhoea
• Pain when urinating
• Fever and cough
• Unexplained weight loss
• Pain that is waking your kid up from sleep or begins to affect their daily lives

Symptoms like these are certainly need an urgent assessment. In case you think your kid has appendicitis, book an online consultation, see the doctor or go to the emergency room right away.

Dr.Suruchi Goyal
Consultant – Paediatrics and Pediatric Endocrinology
Columbia Asia Hospital Whitefield

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The focal symptom of appendicitis is pain that normally starts around bellybutton and then moves to lower right stomach. The ache of appendicitis generally surges over a period of 6 to 12 hrs, and ultimately turn out to be very acute. Anybody can develop appendicitis, but most often attacks people of 10 to 30 age. The standard management for appendicitis is surgical removal of the appendix.

Symptoms

Symptoms may change eventually:

• Initially it starts aching around bellybutton that usually shifts to lower right stomach.
• When swelling feasts to close tissues, the pain may go sharper and become severe.
• Ultimately, the pain inclines to settle in lower right stomach — near appendix at McBurney point. A point is about halfway between bellybutton and the top of right pelvic bone.

But the position of pain may fluctuate, based on age and position of appendix. Young children or pregnant, specifically, may have pain at different places.

What makes pain worse?

If gentle pressure to the area is applied, it hurts and feel tender. When a pressure is realised, particularly if done abruptly, pain will worsen (rebound tenderness). Patient face acute when coughed, while walking or make other shaking movements. This is mostly true if the swollen appendix is touching the peritoneum — the silk-like membrane that lines the inner stomach wall and encloses the intestines. The pain may decrease if patient lie on one side and pull their knees up toward their chest.

Symptoms other than pain

In addition to pain, patients may have one or more of the following:

• Nausea and sometimes vomiting
• Loss of appetite
• A low-grade fever that starts after other symptoms appear
• Constipation
• An inability to pass gas
• Diarrhea
• Abdominal swelling

Causes

The cause of appendicitis is not always clear. Sometimes it’s the outcome of:

• An obstacle. Food waste or a hard stool can get stuck in an orifice of the cavity that runs the length of appendix.
• An infection. It is caused due to gastrointestinal viral infection, or it may be due to other inflammation.

In both cases, bacteria may enter rapidly, making the appendix inflamed and filled with pus. If not treated punctually, appendix is probable to rupture.

 When to get medical advice?

Children are more vulnerable to ruptured appendix. Children may not always have usual symptoms. So, it’s best not to neglect abdominal pain. Even if stomach ache isn’t acute, call doctor for advice.
Older adults also have a higher chance of getting ruptured appendix, perhaps because of delay in consulting doctors.

Tests and diagnosis

The pain may change over time, so diagnosing can may be difficult. In addition, stomach pain can also arise due to other health problems. Other conditions with abdominal pain that may resemble appendicitis are:

• Ectopic pregnancy – occurs outside the lining of uterus
• A right-sided ovarian cyst may cause pain.
• Kidney stone. Sporadically, a stone from the right kidney will pass to ureter, runs from the kidney to the bladder, and get stuck. This causes substantial pain.
• Crohn’s disease. Chronic swelling of the digestive tract, also can mimic appendicitis.

Diagnosis

When gentle pressure on the painful area is suddenly released, pain will go worse if the adjacent peritoneum is inflamed. Other signs include stomach inflexibility and stiffness of abdominal muscles for pressure.

Oher procedures:

• Blood test – To check for a high white blood cell count, which may indicate an infection.
• Urine test.
• X-ray or ultrasound scan.

Universally, a computerized tomography (CT) scan is used for confirming a diagnosis. A CT scan is used to get a more comprehensive view of internal organs.

 Complications

When appendix ruptures, patient may suddenly feel better. But soon afterward, entire abdomen may become distended with gas and fluid and will likely feel tight, hard and tender to the touch. And experience pain throughout belly, but may not have the severe pain. Further, patient may not be able to pass gas or bowel because of the swelling. Other symptoms are fever, thirst and a low urine output. Peritonitis is a medical emergency.
Sometimes, infection and the seepage of intestinal contents may form an abscess, a walled-off area of infection. The abscess may be as small as a walnut or as large as a grapefruit. Regardless of its size, it requires treatment before the abscess itself perforates, causing peritonitis.

Treatments and drugs

Appendicitis treatment requires surgical removal of appendix. Surgeon may perform traditional open surgery (using a single abdominal incision), or laparoscopic surgery, (only a few small abdominal incisions).

In general, laparoscopic surgery allows to recover faster and heal with less scarring. But if your appendix has ruptured and infection has spread beyond then there is necessary for larger incision to clean the abdominal cavity.

Dr. Chalapathy

Vydehi Institute of Medical Sciences & Research Centre,
#82, Nallurahalli, Whitefield, Bangalore – 560 066
+91-80-49069000, +91-80-28413382, +91-80-28410871/2/3/4

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