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Appendicitis is an inflammation of the appendix, which is the small, finger-shaped pouch attached to the beginning of the large intestine on the lower-right side of the abdomen. Appendicitis is a medical emergency, and if left untreated, the appendix may rupture and cause a potentially fatal infection.
In children, appendicitis is the most common abdominal medical emergency and most common pediatric emergency surgical procedure. Although the appendix has no known function, it can become inflamed and diseased. This condition, called appendicitis, can rapidly evolve into a life-threatening or fatal infection of the abdominal cavity (peritonitis) if not treated immediately. Appendicitis usually involves emergency consultation with a physician and evaluation in a hospital emergency department.
Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis in his or her lifetime. The incidence is highest among males aged 10 to 14, and among females aged 15 to 19. More males than females develop appendicitis between puberty and age 25. It is rare in infants and children under the age of two. In the United States, appendicitis occurs in four out of 1,000 children.
Appendicitis is usually caused by a blockage of the inside of the appendix, which is called the lumen. Most often, the lumen is blocked by fecal material. Lymphoid tissue, which is present in mucosal lining of the appendix and intestines to help fight bacterial and viral infections, can swell and lead to obstruction of the appendix. This condition, called lymphoid hyperplasia, may also be associated with a variety of inflammatory and infectious diseases, such as Crohn's disease, gastroenteritis, respiratory infections, mononucleosis, and measles. Appendicitis can also be caused by foreign bodies (e.g., intrauterine device or something swallowed), traumatic abdominal injury, or tumors. In addition, genetics may play a role in appendicitis; some children may inherit genes that make them more susceptible to blockage of the appendiceal lumen. Having cystic fibrosis also increases a child's risk for appendicitis.
Blockage of the appendix then causes inflammation, increased pressure, and restricted blood flow, leading to abdominal pain and tenderness in the right lower quadrant of the abdomen. If the appendix is not removed, bacteria and inflammation within the appendix rapidly expand, the wall of the appendix stretches, and perforation can occur. Once the appendix is perforated, bacteria-filled fluid is released into the abdominal cavity and peritonitis then develops. Perforation is more common in younger children. Perforation can occur as soon as 48 to 72 hours after symptoms first begin and can become life-threatening.
Classic symptoms of appendicitis include the following:
Other possible symptoms are pain on urination, inability to urinate, or frequent urge to urinate if the swollen appendix is near the urinary tract and bladder. When perforation occurs, abdominal pain becomes more
Symptoms of appendicitis vary, and not every child will have all the symptoms. In children younger than age two years, the most common symptoms are vomiting and a bloated or swollen abdomen. Toddlers with appendicitis may have difficulty eating and may seem very tired. Children may have constipation, but may also have small stools that contain mucus. Although infants and children younger than two years may also have abdominal pain and other symptoms, they are too young to effectively communicate their symptoms to adults, who may then miss the symptoms of appendicitis.
Author Info: Jennifer E. Sisk M.A., Thomson Gale, Gale, Detroit, Gale Encyclopedia of Children's Health, 2006
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