Appendicitis is an inflammation of the appendix, a finger-like glandular piece of tissue that connects to the beginning of the large intestine, usually at the lower right side of the abdomen. In older children, the classic symptoms of appendicitis are abdominal pain, fever, and vomiting. Abdominal pain usually begins in the center of the abdomen, around the area of the navel ("belly button"
. Later, the pain may move downward and to the right - to an area called McBurney's point, roughly corresponding to the location of the appendix in the lower right portion of the abdomen.
After his abdominal pain begins, a child with appendicitis usually develops a slight fever, loses his appetite, feels nauseous, and may vomit. The fact that abdominal pain begins before nausea and vomiting, rather than after, is one clue to suspect appendicitis rather than an intestinal infection.
Other symptoms that may be seen in older children with appendicitis include: diarrhea (usually small stools with mucus); urinary tract symptoms (urinating very frequently and/or an uncomfortably strong urge to urinate); constipation; and, sometimes, respiratory symptoms.
In children younger than age 2, the most common symptoms are vomiting and a distended abdomen (abdomen that is bloated or swollen). These children may also have abdominal pain, but either they are too young to be able to tell adults about it, or adults miss the symptom entirely. Because appendicitis is rare in infants, and their symptoms are not "classic," the diagnosis of appendicitis is often delayed in these children. Often, in children between ages 5 and 9, appendicitis is diagnosed as either gastroenteritis or a respiratory infection - much more common illnesses in this age group.
Diagnosis of appendicitis can be difficult. Sometimes it masquerades as other conditions. Sometimes other conditions, particularly certain gastrointestinal infections, can seem to be appendicitis. Even the most experienced physicians and surgeons are not able to diagnose appendicitis 100% of the time. No laboratory test is specific for appendicitis and X-rays are not helpful. However, the use of CT scans to visualize the appendix is becoming more of a standard in helping surgeons to confirm appendicitis when the diagnosis isn't clear.
If appendicitis is not treated, the infected appendix may perforate (break open) and spread its infection to wider areas of the abdomen. If perforation does happen, the child's abdominal pain may spread out to involve the whole abdomen, and fever may be very high. Perforation with appendicitis is more common with younger children.
