What is Appendicitis?

📎 The Appendix is a worm like structure attached to the first portion of the large intestine called cecum and found in the right lower part of the abdomen. Initially thought to be a useless structure, it is now found to aid the immune system. It harbors bacteria. Appendicitis occurs when mucus, stool, or a combination of the two blocks the opening of the appendix that leads to the cecum. Bacteria proliferate in the trapped space and infect the lining of the appendix. If the inflammation and blockage are severe enough, the tissue of the appendix can die and even rupture or burst, leading to a medical emergency. 

Reasons for children to get appendicitis:

📎 Studies have reported that the appendicitis incidence to vary according to dietary habits, hygiene, socioeconomic status, ethnicity, seasonal changes, positive family history, age and gender. Low fiber intake and the resulting constipation are thought to be the cause of childhood appendicitis in 70% of the cases.

 How do we Diagnose   appendicitis in a child:

📎 The common complaint or symptom of appendicitis is a sudden appearance of abdominal pain in the right lower abdomen, often associated with vomiting and fever. The surgeon elicits several clinical signs to diagnose appendicitis, the most common being the ‘MC Burney’s point rebound tenderness’. However, these symptoms and signs described may not always be present in a child, making the diagnosis more difficult and resulting in delays in diagnosis. The progress of the disease is more rapid in children, resulting in the rupture (perforation) of the appendix causing progressive pus formation. Manyatimes other conditions in children mimic appendicitis like pneumonia, severe intestinal infection or rarely an ovarian condition in a girl child. It is important to accurately establish the diagnosis before any surgical intervention. A good history and a detailed examination of the child clinches the diagnosis most of the time, but sometimes need confirmation by imaging in the form of an ultrasound scan or rarely Computed Tomography scan.

 Facts about childhood Appendicitis:

📎 Childhood appendicitis is on the rise and increasingly seen in younger and younger children.

📎 Rarely, newborn babies too have been reported to have appendicitis. 

📎 A general trend towards a diet with less fiber could be the cause of increasing incidence of appendicitis in children.

📎 The symptoms of appendicitis may not be as classical as seen in adults and may delay the diagnosis.

📎 Appendicitis in children more commonly progresses rapidly to advanced stages like rupture.

📎 Appendicitis is treatable by laparoscopy just like in adults in any stage.

 Has the incidence of appendicitis in children increasing in recent times?

📎 Some advances which are obviously good for any society like better hygienic conditions and better socioeconomic status are paradoxically related to increasing incidence of appendicitis. India is in this league of countries where appendicitis in children is unfortunately increasing. In a study published from Canada in 2017, the incidence of appendicitis is increasing rapidly in the developing countries. Even more concerning data emerged from University Hospitals; Leicester, UK in the same year where researchers concluded that the incidence of appendicitis was significantly increasing in children less than 14 years.

   Can there be problems after successful surgery? 

📎 There can be disease related or procedure related long term issues. If the appendix was found ruptured with a lot of pus in the abdomen, there is a small chance of bowel loops getting stuck in these areas and cause blockages requiring re operations. If the operation is done laparoscopically then the procedure related complications like wound infection, hernia in the wound and intestinal blockages are very minimum.