What is appendicitis?
Appendicitis is an infection, inflammation or swelling of the appendix. The appendix is a small, tube-like structure attached at the first part of the large intestine, called the colon. It is usually located in the lower right side of your child's abdomen (belly). It has no known use in the body.
Appendicitis happens when the appendix becomes infected or blocked. The blockage or infection causes the appendix to swell. The swelling can cause pain, diarrhea, vomiting (throwing up) and fever.
If the doctor thinks your child might have appendicitis, they will do a physical exam. They may also order an ultrasound or computed tomography (CT) scan.
What is an appendectomy?
If your child has appendicitis, it usually means your child will need surgery (an operation) to take out the appendix. This operation is called an appendectomy. It is a common procedure. Removing the appendix will not affect your child's growth or their ability to digest foods.
An appendectomy may be either an emergency surgery or a planned surgery, depending on your child's condition. Your child's doctor will decide if your child needs to stay in the hospital or can come to the hospital on the day of the surgery.
Why is my child getting an appendectomy?
Appendectomy is performed to definitively treat appendicitis.
How and when is an appendectomy performed?
Appendectomy can be done safely with small "keyhole" incisions (laparoscopic appendectomy) to minimize pain from incisions. Antibiotics are given with the procedure. For appendicitis without any signs of infection around the appendix (the appendix is not perforated, meaning it has not ruptured or burst), appendectomy is the definitive treatment, and no further antibiotics will be required after the operation.
However, in some cases, the appendix might be perforated, and the infection may have spread inside the belly, causing the belly to be distended or even cause abscesses (infected fluid) to form around the appendix. This means that more antibiotics will be required to treat the infection in addition to the appendectomy. When the infection is more advanced (e.g., your child has had symptoms for more than five days), it may be difficult to find the appendix at surgery because of abscesses or because the appendix is covered with other bowel (phlegmon). If that is the case, your surgeon may recommend treating the infection first with antibiotics, draining abscesses and postponing the appendectomy until the infection has been completely treated.
With laparoscopic appendectomy, there is a very small risk of bleeding, infection and damage to adjacent organs. Your child's health-care team will discuss these risks with you.
Preparing for an appendectomy
Prepare for your child's surgery by asking questions about the procedure, the preparation required and the expected recuperation period. For more information about preparing for surgery, please see:
Your child may be eligible for the "SNAppy" (Same-Night Appendectomy) pathway. In some cases, children with non-perforated (not ruptured or burst) appendicitis can be discharged safely home from the post-anaesthesia care unit (PACU) within one to two hours of the procedure.
During the appendectomy
Your child will receive a general anaesthetic. This helps make sure your child sleeps through the operation and does not feel any pain.
The surgeon will make incisions (cuts) in your child's abdomen. The surgeon may also use a camera called a laparoscope and make small cuts. The surgeon will remove your child's appendix and sew up the bowel where it was attached. Then, the surgeon will close the incisions using small pieces of tape called steri-strips and stitches that dissolve.
After the appendectomy
After the appendectomy, your child will go to the Post-Anaesthesia Care Unit, also called the PACU or recovery room. They will stay there for about one hour. You may visit your child once they wake up.
If the appendix was not perforated (burst), then you may be discharged from the PACU on the same day as the surgery. Your child may go to the inpatient unit if they need more antibiotics.
Your child can go home when:
- Their heart rate, breathing, blood pressure and temperature are normal.
- They are able to drink clear fluids.
- They are comfortable taking pain medicine by mouth.
Taking care of your child at home
Care of the incision
The incisions from the surgery will be covered by a dressing called steri-strips or Mepore. You do not need to do anything to the strips. Wash your hands before touching or cleaning the incision area.
A small amount of blood on the strips is common. If the blood seems fresh or if the amount of blood increases, press on the area with a clean washcloth for five to six minutes. Then call your child's surgeon's office.
If the bleeding does not stop, take your child to a family doctor or to the emergency department.
There may be clear or yellow drainage from the bellybutton for up to two weeks after surgery—this is normal.
The steri-strips will fall off on their own. You can remove the strips if they have not fallen off seven to 10 days after your child's surgery.
Activities
Your child can go back to normal activities once they feel able.
Diet
Your child should be able to return to their normal diet after the surgery. It is common for children to feel nauseous after receiving anaesthesia for upwards of 24 hours. If your child has problems eating, call your surgeon's office.
Pain medicine
When your child comes home, you may want to give acetaminophen and/or ibuprofen for the first 24 to 48 hours after surgery. Follow the instructions on the bottle for the amount of medicine to give to your child. Your child can have pain medicine as needed after the first 24 hours.
Bathing
You can give your child a bath 48 hours after surgery.
School
Your child may go back to day care or school when they feel able and you feel comfortable with them returning to their normal routine.
Follow-up care for appendectomy
Your child's surgeon might want to check in on them to make sure everything is going smoothly. Either they or a nurse could give you a call or share some test results with you over the phone.
If your child had perforated (ruptured or burst) appendicitis and did not have surgery, the doctor might want to talk in person at the clinic after your child is sent home from the hospital. They might discuss a plan for surgery later (electively).
If your child is doing well, then it is safe to follow up with your regular health-care provider as needed.
When to call the surgery team
The main concern after an appendectomy is an abscess (infection). Call your child's surgeon's office if you notice any of the following signs or symptoms of infection in your child:
- fever of 38.5°C (101°F) or higher
- thick yellow or green foul-smelling discharge from the incision area
- bleeding at the incision area
- redness at the incision area
- swelling at the incision area
- pain that gets worse, even after taking pain medicine
- less appetite or vomiting (throwing up)
- stomach pain or distention (swelling or fullness)
- your child feels lethargic or very tired or drowsy
If you have a question or a concern that is not urgent, call your child's surgeon's office. If you have an urgent concern, take your child to their primary care provider or the nearest emergency department.
At SickKids
The General Surgery clinic is located on 6D in the Atrium.
For more information, please visit the General Surgery Clinic website: https://www.sickkids.ca/en/care-services/clinics/general-surgery-clinic/