Removing an inflamed appendix (appendicectomy)

What is the appendix?

The appendix is a blind ending tube, which is connected to your large bowel. It is on the lower right side of your tummy. We do not yet know what the appendix does or is for, but we think it may help with maintaining healthy gut bacteria.

What is appendicitis?

Appendicitis is an inflammation of the appendix and is a surgical emergency. It is a common cause of abdominal pain in children. Other symptoms may include:

• feeling sick
• being sick
• loss of appetite
• high temperature

The reason why the appendix becomes inflamed is often not known.

It may caused by something blocking the appendix opening. This causes the appendix to swell and become infected. The appendix can then burst.

This is very serious as the infection can spread in the tummy and cause peritonitis, or collect into an abscess which collection of pus. Appendicitis can be treated by having an operation called an appendicectomy to remove the appendix.

How is appendicitis diagnosed?

Appendicitis can be difficult to diagnose because there may be a variety of symptoms. The doctor will examine your child’s abdomen and may recommend an ultrasound scan or blood tests to help make sure it is most likely appendicitis.

There is no test that can definitely prove it is appendicitis. Sometimes the doctor will recommend waiting a few hours or a day, and sometimes they will recommend an immediate operation.

The surgeon cannot be absolutely sure that your child has appendicitis until the operation itself, but the surgeon will always have a good look around inside the tummy to find if there is any other problem that needs to be sorted out.

Are their any alternatives to surgery?

Surgery is usually the best choice of treatment, but in a few cases a course of antibiotics may be used. Your doctor will explain this to you if it is thought to be the best treatment in your case.

What are the risks?

Appendicectomy is usually a straightforward  operation (particularly if the appendix has not burst) but the following can happen:

Infection

For simple acute appendicitis the risk of wound infection is low but the risks increases for a perforated (burst) appendix. Antibiotics will usually clear this.

Abscess

An abscess is a collection of pus (infection), which may form inside the tummy, especially after a burst appendix. This may be treated with just antibiotics but if  the abscess is large, the pus may need to be drained.

Abdominal adhesions

Abdominal adhesions are internal scar tissue which may form bands across the tummy which can trap the bowel. This may cause tummy pain or bowel obstruction. This could happen shortly after or even years after the operation.

What will happen before the operation?

Sometimes your child may not go for an operation immediately. If not, we will start your child on antibiotics, strong painkillers and they are not allowed to eat.

Not letting your child eat is important to make sure that the general anaesthetic is safe.

What happens during the operation?

The operation is usually started by using keyhole surgery but may need to be changed to an open operation with a larger cut. All the cuts are closed with glue or stitches that do not need to be removed.

What will happen after the operation?

After a straightforward appendicectomy your child can start drinking when they get back to the ward. If they are not sick, they can start eating their normal diet and they should be ready to go home 1 or 2 days after the operation.

If the appendix has burst your child may not be able to start eating immediately as the inflammation can stop the bowel working and make them sick. Fluids into the veins and antibiotics may need to be continued for several days. Your child can take a shower 2 days after the surgery unless told not to.

When will my child be discharged?

Your child will be able to go home once they:

• are able to eat normally or
• are able to take antibiotics by their mouth, and
• have not had a fever for up to 2 days.

Your child can go back to school once they feel well enough. This is usually 1 week or less for an unruptured appendix and 2 weeks or more for a ruptured appendix.

We will write to your child’s GP to tell them about your child’s operation.

When should I be concerned?

You should  be concerned if:

• your child develops a fever of 38 degrees Celsius or above
• your child’s tummy swells
• the wound becomes red, swollen or hot
• the wound is oozing thick fluid
• your child is not recovering as you would expect
• is off food and being sick

If you are are concerned about one or more of these problems please see your GP urgently or go to your local Emergency Department.