Appendectomy

Appendicitis is an inflammation of the appendix. The appendix is found at the end of the intestine in the lower right-side of the abdomen. It is the most common condition requiring abdominal surgery during childhood.

How do I know if it is appendicitis?
Signs may include poor appetite; fever; vomiting; restlessness; irritability; a significant change in behavior; and/or generalized pain that occurs particularly around the bellybutton at first (however, it may change to the lower right-hand side). It is not always simple to diagnose. For example, fever; vomiting; abdominal pain; and elevated blood count can also associated with other abdominal illnesses.

What if it is appendicitis?
The treatment is surgical removal of the appendix (appendectomy). Your child will not be allowed to eat or drink anything before surgery, and if he has beeen ill for a long time, he may need to have IV fluids before surgery. You will be able to walk with your child to the doors of the operating room. There is a waiting area on the second floor outside the Operating Room where you may stay during your child's surgery.

What can I expect after the operation?
Usually the surgeon, or nurse will come find you when your child's surgery is finished, or when he is moved to the recovery room. Your child will be very drowsy after surgery, and may be fussy or confused when he awakens for brief periods. This is usually due to the anesthesia, and/or pain medications "wearing off". It will help him, if you can remain with him after surgery while he is going through this period. You are a familiar and comforting face to him. After surgery, the nurse will ask your child to turn over, to move about in the bed, and to take deep breaths (if old enough to understand to do so). Ask your nurse about pain management. Keeping pain to the absolute minimum is important to ensure that your child is up and walking soon after surgery. This helps to increase bowel activity, helps to decrease pain, and decreases complications. Encourage your child to walk to the playroom to play during its open hours. Diet is increased as the child's intestines "wake up" and in relation to the child's tolerance. Recovery is usually rapid. If there are no complications, the child may be discharged within a day or two.

What is a "ruptured appendix"?
Sometimes the appendix is so infected that it actually "bursts open". This is because of the pus that builds up inside the appendix when it is infected. This causes the added possibility of the infection spreading to the inside of the abdomen around the stomach and intestines. This is called peritonitis and needs to be treated with antibiotics. Sometimes the doctor may suspect that the appendix has ruptured and may start antibiotics even before surgery. If the appendix has ruptured, antibiotics will be continues during and after surgery for several days. A nasogastric tube is often placed through the nose and down into the stomach tIt will be attached to a suction machine to keep the stomach empty until intestinal activity starts again. The incision in the abdomen may be left open for a few days if infection is present, or a drain (a small rubber tube) may be placed in the incision to allow pus or extra fluids to drain from the appendix area. The dressing may or may not need to be changed on a regular basis. The child should be positioned in a low sitting position to reduce the chances of spreading the infection to other parts of the abdomen. Intravenous (IV) fluids are used to give liquid to the child who is usually not allowed to eat or drink anything for several days. The course of recovery is longer for a child whose appendix has ruptured. They may be hospitalized for 7-10 days.

What can be done to help your child deal with this event?
Your Nurse and/or the Play Lady will explain what your child might expect to see, feel and smell in the operating room. The Play Lady has toys, games, and books that will allow your child to "play" and deal with his hospitalization and surgery. This "play" period will most likely occur after surgery as the child may be too ill before he has his appendix removed It is important to gauge the child's emotional reaction to hospitalization and surgery. Some children believe they are being punished. Help your child to understand the need for surgery and post-operative care in ways appropriate to his/her age and level of understanding. Your child might regress a little in reaction to the stress of illness, hospitalization, and surgery. For example, if your child has just become sucessful using the toilet at home, don't be upset if he/she wets the bed and needs diapers now. Children who haven't used a bottle for a while might want one simply for comfort or reassurrance. These are very normal reactions.and should be expected.