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Delayed Treatment for Appendicitis Can Mean a Long Recovery

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Wednesday, February 7th, 2007 Bruce Kennedy | CWK Executive Producer

“When it ruptures, that pressure that’s been going on is released – and there is a temporary, sometimes, a temporary relief of pain or at least attenuation of pain; it becomes less. And then, after a short period of time, the pain becomes worse.”

– Lonnie King, M.D., Children’s Healthcare of Atlanta

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It’s a small, tube-like organ connected to our intestines – but doctors say they’re not sure what, if any, purpose an appendix has. One thing they do know: if you think your child has appendicitis – an inflamed appendix – seek medical attention at once.

15-year-old Michael has had abdominal pain for four days. By the time he came to the ER, the pain was almost unbearable.

“A day or so into the pain he had a short period where he felt better, and then the pain got worse,” says Dr. Lonnie King with Children’s Healthcare of Atlanta. “And it had gotten to the point where he had trouble walking, getting up, getting down, sitting, coughing – anything like that made it hurt. “

Michael has the classic symptoms of appendicitis. But he may have waited too long before coming to the hospital.

“After the appendix is inflamed long enough that [it] becomes very inflamed and infected, it can rupture,” says the doctor.

A ruptured appendix spreads infection inside the abdominal cavity. A half-century ago, it was considered a death sentence. But today, with antibiotics and surgery, the fatality rate is nearly zero.

Michael’s prognosis is good – but he faces a long recovery.

“He’ll have an IV for at least two weeks, to get antibiotics,” says Dr. King. “He’ll probably just stay in the hospital for a week, and then go home with an IV – so that he gets antibiotics at home for probably about two weeks.”

And after the antibiotic treatment, he’ll still have to get what’s left of his appendix removed. Appendicitis caught early, however, can be treated quickly – with laparoscopic surgery.

“If an appendix is inflamed but not ruptured,” says the doctor, “the procedure is very quick – and many times these children leave the hospital the next day, after their operation.”

An inflamed appendix can burst within a day or less of its first symptoms – which, many times, is a persistent stomach pain.

“And that means if it lasts more than several hours,” says Dr. King, “I think anyone should get checked if they have persistent abdominal pain.”

What We Need To Know

  • Appendicitis symptoms commonly start with a low fever and mild pain around the bellybutton – sometimes accompanied by constipation, nausea or diarrhea. The stomach pain usually worsens – and moves to the lower right side of the abdomen. (Nemours Foundation – Center for Children’s Health Media)
  • An inflamed appendix is a serious medical condition and can become a life-threatening problem. Call your physician immediately if you think your child has appendicitis. (Comer Children’s Hospital – University of Chicago)
  • Most appendicitis cases are diagnosed by medical history and physical examination alone. For patients with signs and symptoms that are not clear, diagnostic tests such as ultrasound and computed tomography (CT) scan may be used. (The Cleveland Clinic)
  • Surgical removal of an inflamed appendix is still considered the best treatment for appendicitis. In uncomplicated cases, many children are discharged from the hospital within 24 to 48 hours of their appendectomy – and can resume school and other normal activities in a week or so. Treatment is more complex for children who are brought in several days or weeks after their symptoms have begun. Some may need immediate surgery; others may require several weeks or intravenous antibiotic therapy and/or CT-guided abscess drainage. And an elective interval appendectomy may be needed several weeks later. (Children’s Memorial Hospital – Chicago)

Resources

  • UCSF Medical Center
  • American Academy of Family Physicians
  • Children’s Hospital Boston
  • The Journal of the American Medical Association

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