Pediatric Appendectomy Surgery : Risk Factors & Recovery

Overview

Attached to the colon – in the lower right part of the cecum (large intestine) – appendix is a finger-shaped organ. Appendicitis can be described as an inflammation or infection of the appendix leading to it getting blocked. The procedure to remove the appendix is called an appendectomy. This surgery is one of the most common abdominal surgeries which if left untreated can result in the appendix getting ruptured. Although it can occur at any given age, more often than not, it afflicts children between the ages of 8-16.

Appendicitis is usually an emergency operation. Simple appendicitis is when the appendix is swollen but hasn’t burst yet. However, complicated appendicitis describes a case where the rupture has already happened resulting in the infection spreading through the abdomen. If left to rupture, it can have serious implications even leading to death. The appendix is not an important organ though and most healthcare professionals and experts are still unsure about its purpose or function. Which is why a surgery to get rid of it isn’t considered to be detrimental to the body’s optimal functioning. As it is, most patients, including children, are said to recover post-surgery without any long-term issues.

Symptoms

Symptoms of appendicitis tend to differ from child to child. The most common symptoms are:

• A feeling of acute pain around the abdomen radiating from the lower right side of the belly. This pain usually spikes up further when the child indulges in any physical activities such as jumping, playing sports, etc.
• Fever
• Nausea
• Vomiting
• Swollen belly – in the case of younger kids
• Constipation
• Reduced appetite
• Diarrhea

Causes and Risk Factors

In most cases, appendicitis is caused due to the presence of a blockage on the insides of the appendix. This results in inflammation and infection. The blockage could be as a result of mucus, stools, a foreign body, or bacteria. In rare cases, blockages can also be caused due to the presence of a bend in the appendix as well.

If this swelling along with the accompanying infection is left untreated, the appendix can perforate as its walls start to get holes. This eventually leads to the toxic contents present inside the appendix to leak into the abdominal cavity resulting in the infection spreading incessantly. If left untreated, it could cause a serious infection known as peritonitis which can prove to be deadly.

What happens during the procedure?

After analyzing the child’s symptoms, a pediatrician will analyze the child’s complete health history and perform a quick physical exam. He might also order several diagnostic tests such as abdominal ultrasounds and X-rays as well as blood and urine tests to ascertain the root cause. Being a medical emergency, the surgeon will advise surgery as soon as possible. Once admitted, the child will not be given anything to consume or drink until after the operation.

Open or traditional surgery: After being administered anesthesia, the surgeon proceeds to make an incision in the lower right-hand side of the abdomen. Once the appendix has been located, the surgeon goes on to remove it surgically. In cases of rupture, however, the surgeon will give the child a round of antibiotics to get the infection under control and prevent it from spreading. It’s imperative to get the infection under control before the operation. Once that’s done, with the help of a small tube, the surgeon will drain out the pus from the child’s abdomen to prevent the infection from spreading. In addition, it needs to be mentioned that the tube might be left in the abdomen for a few weeks to facilitate pus removal. Children with a ruptured appendix usually need to stay a bit longer.

Laparoscopic surgery: Today thanks to modern technology, a laparoscopy can also be performed which is a minimally invasive surgery. A telescope, as well as possibly two other surgical instruments, are used for removal through several small incisions into the abdomen. The organ is then removed through the belly button or navel through an incision which is mostly hidden. In such cases, the recovery time is fairly short.

Recovery Period

Post appendectomy, a child’s recovery, and follow-up care are dependent on whether the appendix was a simple (non-ruptured) or complicated procedure (ruptured). In case of simple surgeries, the child can usually go home the next day or in a couple of days and even resume gentle activities. With the help of medications, the pain will also be under control.

However, in cases where there has been a rupture or a complicated appendectomy, the child will need to be under observation for a week or two post-surgery. He will also be given a course of antibiotics over this period while being in IV fluids as well. In such cases, normal activities can only be resumed 2 to 4 weeks after leaving the hospital. The pediatric surgeon will usually discuss the best recovery procedures for the child with his/her parents.