It can be considered the commonest acute abdominal pain among children between the ages of 3 – 15 years and is also considered to be a surgical emergency due to its complications such as rupture, gangrene and sepsis in untreated patients or in patients subjected to a delay in the treatment.
The condition can manifest due to a bacterial infection of the said organ which may precipitate by poor draining due to a fecal blockage of the entrance to the appendix or else due to a swelled up lymph node. In such instances, the appendix can swell as well as collect pus due to the bacterial activity. The swelling of the mucosal lining of the appendix and thus the stretching of the organ will give rise to many of its manifestations along with a fever that would be precipitated by the disseminating infection.
The diagnosis or detection of an acute appendicitis would depend mainly on the clinical signs although it would be a tough task in a child who cannot describe the manifestations accurately, not corporative due to the pain or else due to different types of manifestations. Even though this is true, knowing the classical signs of an acute appendicitis would help us to at least guess the possibility of appendicitis in a child. Thus, following signs and symptoms need to be looked into as possible indicators of an acute appendicitis.
-Intense abdominal pain initiated around the umbilicus and gradually shifting towards the right side of the lower abdomen.
-Feeling of nausea and vomiting before and while the intense pain is present.
-Occurrence of either diarrhea or constipation.
-Bloated or swelled up abdomen
In most instances, a child with acute appendicitis would not let anyone touch the lower abdomen although an older child or a child in less severe pain might allow a person to check. In such instances, the optimal pain would be felt at a location about 2/3rd of the distance from the umbilicus to the protrusion present in the front portion of the hip bone. At the same time, in certain instances, rigidness of the abdomen would also be found along with a phenomenon known as ‘rebound tenderness’ when the person complain of more pain when a finger pressing on the region is withdrawn.
Although at times these clinical findings are fairly suggestive of an acute appendicitis, it would be supported by imaging studies such as ultrasound scan, CT or MRI to ascertain the exact location and the degree of involvement of the appendix. Furthermore, blood tests would be done in order to detect the level of systemic manifestations of this condition.
Based on these findings, the clinicians would be able to undertake urgent management decision and in acute appendicitis, the preferred mode of treatment would be to surgically remove the inflamed appendix with a course of antibiotics.