Child Appendicitis Recovery

Acute Appendicitis

Acute appendicitis is common, particularly between the ages of 10 and 30. It generally occurs in children in their teenage years; however, younger children can also get it. It is a common acute condition of the lower belly (abdomen). It involves inflammation of the appendix, a small, tubular pouch, about the size of a finger, attached to the lower right end of the large intestine.

Poop (feces) passing through the large intestine can block or infect the appendix. This leads to swelling/inflammation, causing the appendix to swell; if untreated, it can burst.

Appendicitis is Missed in Younger Children

Signs or symptoms of acute appendicitis can include abdominal pain, vomiting, loss of appetite, and fever. However, these symptoms can be missed in smaller children due to the following possible reasons:

Young children cannot explain how they feel as older children can. This makes it harder for parents and doctors to figure out the problem.
Often, when a child has a sore tummy, is sick, has diarrhoea, or has a fever, families might think it is just a tummy bug. But these symptoms can also be signs of something more serious, like appendicitis.

Sometimes, children’s appendicitis can get worse quickly, especially if they are unable to get the right treatment promptly. That is why it is important to keep a close eye on your child and seek medical help if they are showing signs like abdominal pain, vomiting, or loss of appetite.

Perforation Rate in Younger Children

Younger children are at a higher risk of developing a perforation (hole in the appendix).

Age Group	Risk of a Hole in the Appendix
< 1 year or infants	≈ 100%
< 5 years or young children	> 80%

The higher perforation rate depends on:

Ethnicity
Access to healthcare
Health insurance status
Referral pattern

In short, non-medical factors, like where the child lives, their background, and how quickly they reach medical care, can influence the severity of the appendicitis.

Complications of Appendicitis (Inflammation of the Appendix)

When the appendix bursts, it leads to more complications, longer hospital stays, and higher treatment costs.

The following are the possible complications after appendicitis.

Abscesses: Collections of pus can form in the belly, such as between the intestines, in the pelvis, or near the liver. These are usually caused by infection after surgery.
Intestinal blockage: Scar tissue and inflammation after surgery can cause the intestines to get blocked, usually within the first 3 months. This can happen more often if the appendix has burst.
Fertility concerns (for girls): In rare cases, severe infection can affect the fallopian tubes, which might impact the ability to have children later. However, research on fertility is mixed, and it doesn’t happen often.

Case Summary of 23-Month-Old Girl With Appendicitis

The following case highlights how appendicitis can be missed in younger children and the role of multidisciplinary teamwork in the management.

A 23-month-old girl was brought to Surya Hospitals with tummy pain and vomiting that had lasted for 5 days. A local paediatrician had already seen her; unfortunately, her symptoms did not show any improvement. When she arrived at Surya, she was tired, weak, and had a racing heartbeat. Her abdomen was swollen and painful all over.

An urgent ultrasound of the abdomen was done. The diagnostic test showed perforated appendicitis (hole in the appendix) with fecalith (hardened stool). The consultant paediatric surgeon and the radiology department examined the imaging with both radiology colleagues. The images were unclear because of swelling and inflammation. Hence, to avoid unnecessary radiation exposure in a young child, the team decided not to do a CT scan.

The young girl was started on broad-spectrum antibiotics, and an emergency laparoscopic surgery (a minimally invasive procedure) was planned. The team at Surya Hospitals explained to parents about the risks and benefits in a way they can easily understand. The child’s vital signs were measured; haemoglobin (Hb) was low, 9.5 g/dL, and the C-reactive protein (CRP) was high, 152 mg/L.

After a multidisciplinary team (MDT) discussion with the anaesthetists, laparoscopic surgery was carried out. During the operation, pus pockets were found in different parts of the abdomen, and a free-floating, hardened stool was removed carefully. The appendix was taken out, and a drain was placed to remove excess fluids. The urinary catheter was removed on the 2nd postoperative day.

The child showed signs of recovery of peristalsis; therefore, oral liquids were started; however, later, the child had mild vomiting. An MDT discussion took place with the Paediatric Intensive Care Unit team (PICU) to review the progress. A plan to actively observe her bowel issues was made. The child's nutritional status and the future need for Total Parenteral Nutrition (TPN) were considered.

On postoperative Day 5, she developed an adhesive bowel obstruction (intestinal blockage), a known complication after perforated appendicitis. This was managed using a special liquid medicine (Dilute Gastrograffin) that helped clear her blockage successfully. And thankfully, there was no need for another surgery. She gradually started on feeds, which she tolerated very well. The patient was seen in post operative follow-up clinic and is doing well.

The Outcome & Learning

This is a very good example of multidisciplinary teamwork amongst the team, including paediatricians, surgeons, radiologists, anaesthesiologists, the intensive care team, and the nursing team. Excellent communication, shared decision-making, and keeping the patients informed at all stages of management are key to better care of the critically ill patients. This collaborative working helps in improving patient outcomes.

It also reminds us that in very young children, appendicitis can be easily missed. Parents and doctors should always stay alert when a child’s stomach pain and vomiting don’t improve. Early diagnosis and treatment can prevent serious complications like intestinal blockage.