TulsaKids Editor Betty Casey interviews Dr. Barry Birch about appendicitis. Dr. Birch is a fellowship-trained, board-certified pediatric general surgeon and thoracic surgeon. He provides a wide range of surgical services to infants, children and teens at St. Francis Children’s Hospital.
What is appendicitis?
The appendix is the part of the intestine that looks like a finger-like protrusion that protrudes outward from the first part of the colon where the small intestine meets the large intestine. Appendicitis is an inflammation of the appendix that can lead to an infection, sometimes a very serious infection.
Appendicitis is much more common than many people, certainly many parents, realize. The more people know about this, the sooner they can get help for their child and prevent serious problems.
What are some signs of appendiceal inflammation that parents can look out for?
Classically, pain. The child will say, “My stomach hurts.” It is usually located in the lower abdomen on the right side, just above the hip bone area, between the tip of the hip and the navel. But we see that children exist in many different forms. Pain may appear after you feel generally unwell. Symptoms may include vomiting, fever, nausea, and diarrhea, but it usually begins with complaints of pain.
How common is appendicitis? Can children of any age get appendicitis?
The most important thing that parents need to understand is that appendicitis is very common. Up to 70 to 100,000 cases of appendicitis occur annually in the United States. The numbers could be even higher. Here at St. Francis Children’s Hospital, we see an average of one patient a day. This equates to 365 cases per year, and approximately 300 surgeries achieve this figure fairly closely.
The most common time to get appendicitis is between the ages of 10 and 12 and 17 and 18, but it’s a misconception that children can’t get appendicitis. My family has two children, ages 2 and 5, with appendicitis.
There is also a disease called neonatal appendicitis. I have performed surgery on infants. It’s very rare, but it does happen.
What would you say if your child had appendicitis? What should parents listen to?
If they say they don’t feel well, listen. Please take your child’s complaint seriously. If your child has abdominal pain or other symptoms, take them to your pediatrician or children’s hospital. The more professionally evaluated you can do for your child, the better. Diagnosis can be difficult even for surgeons and doctors who see children every day, so it is important that the child is evaluated by a pediatrician. Imaging such as ultrasound, CT, and laboratory tests can be used to confirm the diagnosis.
Does appendicitis always require surgery? What will happen if it is left untreated?
Yes, the important point here is that the sooner you make a diagnosis and start treatment, the better. We have excellent antibiotics and quick and easy surgeries to treat appendicitis. Treatment is a combination of intravenous antibiotics and surgery. The sooner treatment begins, the better. To stop the progression of appendicitis, it is important to take the patient to the hospital and start intravenous antibiotics.
Over time, inflammation becomes an increasingly serious infection. This can lead to what is called a ruptured appendix. This appendix progresses once inflammation begins. It can eventually turn into gangrene, spreading bacteria throughout the abdomen and causing sepsis. Sepsis is a severe and overwhelming infection that affects the whole body. Starting intravenous antibiotics is the key to starting treatment. The sooner the better.
Depending on the child’s age and size, the infection can progress quickly. After symptoms appear, the infection can progress from slight inflammation to rupture within a few days. For small children, it may take up to 24 hours. Approximately 80% of the children under the age of 5 who come to us already have a ruptured appendix when they arrive. They get sick quickly. In older children, the disease may progress more slowly depending on their size and anatomy, but if antibiotics are not started within 24 or 48 hours, symptoms will only get worse as the days go by. is.
So does this mean that appendicitis quickly becomes serious and cannot be cured on its own?
I am also a parent of three children. One of my kids got appendicitis and it took about 12+ hours before they took it seriously. I suspected this, but children often complain. Is it just constipation or abdominal pain? In the case of appendicitis, he usually knows the symptoms are real within 6 to 8 hours. we went to the hospital.
For some reason, we see patients who are given oral antibiotics and whose symptoms seem to improve, but appendicitis will not improve without antibiotics and surgery.
If your child has to have surgery and it may be their first surgery, how do you talk to them about it?
The word surgery can be scary for anyone, especially children and parents. We do that every day, and we are blessed to have a children’s hospital with so many resources here in Tulsa. Child life specialists, pre-operative area and floor nurses are very good at putting parents at ease. This is what they do every day. As a pediatric surgeon, I hope parents can take comfort in knowing that this is what I do every day. That’s what I’m used to doing.
We try to get the kids on their level and make sure they understand that we’re going to make them better and that they’re going to be okay. When parents can come here and meet a variety of caregivers who are really good at what they do, they feel relieved. Fortunately, it is a simple surgery and patients do very well. Our hospital performs many minimally invasive laparoscopic surgeries.
This is another reason why it is important to detect appendicitis in a timely manner. Surgery is easier and more likely to be successful. Children usually stay overnight after surgery. Depending on the severity, hospitalization may be longer than 3 days.
Therefore, having a team that truly understands pediatrics and pediatric surgery is extremely important for both children and parents.
It’s very important. I think pediatric care is sometimes undervalued, and we’re very fortunate to have St. Francis Children’s Hospital here. My message to all parents is to take your sick child to a pediatric specialty center, whether it’s a pediatric outpatient clinic or a pediatric emergency center.
That’s a wonderful ending. Remember this is common and you need to bring your children in early and believe if they have pain or symptoms like the one you describe and work with someone trained in pediatrics. there is. Is there anything else you would like to leave behind?
My final word to parents is to take your child’s complaint seriously. I’ll ask you to check out. It’s better to be safe than sorry. As a parent myself, I understand that everyone is busy and it’s easy to trivialize. But kids usually know when they’re sick, and fortunately, most parents are good at knowing when their kids are sick. Please take them to the right place and I hope we can take care of them.
Thank you very much. Thank you, Dr. Birch. We would also like to thank St. Francis Children’s Hospital for providing this information to parents. That’s very important. This interview and others can be found in PJ’s corner of TulsaKids Magazine or at tulsakids.com.
