Acute Appendicitis in Children

Acute appendicitis is a sudden inflammation of the appendix and is considered a surgical emergency. The appendix is a small blind pouch attached to the large intestine on the lower right side of the abdomen. Its exact purpose is not fully understood, so it can be safely removed when appendicitis occurs.

What is appendicitis?

Acute appendicitis can develop in stages:

• Obstruction
• Inflammation
• Ulceration and gangrene
• Perforation

It most commonly affects children between 8 and 11 years of age, although it can occur at any age. Symptoms may vary from child to child.

Common symptoms

• Pain that starts around the belly button and then moves to the lower right side of the abdomen within a few hours
• Loss of appetite
• Nausea
• Vomiting
• Fever, which is often a later sign

Clinical diagnosis can sometimes be challenging because the appendix can lie in different positions in the abdomen. During assessment, the doctor may perform specific clinical tests to support the diagnosis.

• Pressing on the tummy in specific areas
• Moving the leg in certain ways
• Hop sign, where the child is asked to jump or the area under the right heel is gently tapped with the leg extended

Imaging tests

Imaging is not necessary in every case, but an ultrasound scan or CT scan may be used to support the clinical diagnosis when needed.

Management

Treatment depends on whether the appendicitis is simple or complicated, and also on how long the symptoms have been present.

Simple appendicitis

• Initial treatment includes pain relief and antibiotics
• Appendicectomy is the definitive treatment
• When there is a short history and no perforation, surgery can often be done promptly

Complicated appendicitis

• With perforation and a short history, IV fluids and antibiotics are usually started first
• Appendicectomy may be performed after clinical improvement
• With a longer history and an appendix mass, conservative treatment may be advised first, followed by interval appendicectomy after around 3 months
• If there is no clinical improvement, surgery becomes necessary

Surgical options

Open surgery is now almost obsolete in many cases. Laparoscopic surgery is commonly used and usually involves three small incisions for the camera and instruments.

SILS, or single-incision laparoscopic surgery, is a further advancement. It uses one incision through the belly button, which can offer better cosmetic results.

There are two main SILS techniques:

• Intracorporeal SILS appendectomy, where the procedure is completed inside the abdomen using laparoscopic instruments
• Exteriorisation technique, where the appendix is delivered through an umbilical incision and removed outside the abdomen, similar to a mini open operation

Advantages of SILS

• Faster recovery after surgery
• A single small incision hidden under the belly button for a better cosmetic outcome

Possible challenges of SILS

• A learning curve because the technique is newer and more specialised
• Instrument crowding through a smaller incision, which can make the operation technically more demanding

SILS in Lahore

Dr. Abid Qazi is a senior paediatric surgeon with more than 30 years of experience in paediatric surgery. He has used SILS as a standard technique for many paediatric procedures, including appendicectomy, and has helped many children recover successfully.

He is available for in-person consultations in Lahore as well as virtual consultations and second opinions. To request an appointment, please email info@abidqazi.com, send a WhatsApp message to +92 317 4002444, or visit the Contact page.

Early assessment can make a real difference in children with suspected appendicitis.