• 24/01/2023
• By wizewebsite
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Appendicitis: Which symptoms can already be a warning signal?<

Do you have a "blind man" outside? You may have experienced this question before in your life. The so-called appendicitis, more precisely inflammation of the worm-like appendage of the appendix, or appendicitis, belongs to quite common diseases of childhood. But they don't have to avoid adults either.

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Although the "blind", 5 to 10 centimeter long part of the large intestine seems quite unimportant, it can cut a nice patch of trouble if it is not intervened in time. This part of the intestine has remained in us as such a developmental remnant, and the removal of the "blunt" will not endanger the quality of life in any way.

The exact cause of the inflammation is not completely known. One possible variant is blockage of the appendix with development into inflammation. This blockage can be caused, for example, by swelling of the mucous membrane or by a hardened mass formed by stool, a so-called coprolite. However, intestinal imbalance can also be the reason.

Has the child's behavior changed? Pay attention.

Clinical symptoms of appendicitis are influenced by the age of the child as well as the position of the worm-like appendage of the intestine. But the basic warning signs include:

As stated by the head of the Department of Pediatric Surgery and Traumatology at the Faculty Hospital Bulovka MUDr. Karel Harvánek, it is important to know that not all symptoms may be present. Sometimes they can be only indicative, some can be missing completely. "I recommend visiting a doctor whenever any of the symptoms lasts for about six hours and despite calming the patient and dietary measures, the symptoms do not subside or even become more pronounced," he adds.

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Infants and the appendix: a rapid and severe course

In infants, however, the disease progresses according to MUDr. Jan Pastor from the 3rd surgical clinic of the 1st Faculty of Medicine of the University of Warsaw and the Motol General Hospital, usually atypically with a rapid onset of symptoms and a severe course.

"In toddlers and infants, there are non-specific symptoms reminiscent of enterocolitis or dyspepsia (diarrhea, vomiting). In children of preschool and school age, appendicitis is similar to that in adults - first there is pressure pain above or around the navel, which within a few hours moves to the right lower abdomen, gradually becoming sharp, stabbing and worsened by movement," explains MUDr. Pastor.

However, vomiting and abdominal pain may not occur immediately. In young children, one of the warning signs can be a change in the behavior pattern, where the child sleeps during the day, has no appetite, is not interested in toys and other normal activities.

Appendix: remove or "dispel"?

When a child is diagnosed with appendicitis, the patient usually goes straight to the operating room. This operation, the so-called appendectomy, has been performed for more than 120 years, and in the last 30 years it has mostly been performed laparoscopically, i.e. minimally invasively.

"In the smallest children, an open approach is preferred, where the appendectomy is performed from a small incision (approx. 2 cm) in the right lower abdomen. The complexity of the operation is mainly determined by the progress of the inflammatory changes and the general condition of the child. If the situation during laparoscopy is unclear, it is switched to open surgery," describes the methods of surgery, MUDr. Silvia Jaroščiaková from the 3rd surgical clinic of the 1st Faculty of Medicine of the UK and FN Motol.

In principle, however, it is a fairly common procedure, and if there are no complications, according to Chief Harvánek, it is a simple, uncomplicated operation that is not demanding for either the patient or the operator. Of course, the difficulty increases with possible complications.

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Is appendectomy always necessary?

In principle, yes, because it mainly serves to prevent the rupture of an inflamed appendix, which could lead to unlimited peritonitis, according to Doctor Pastor. It is an immediate life-threatening condition. "Attempts to disperse (e.g. icing) are inappropriate and dangerous. Avoiding surgery is wrong," warns the mayor, Karel Harvánek.

Conservative procedure is recommended by the surgeon only in limited inflammation, the so-called periappendicular infiltrate. "The infiltrate manifests itself as a painful bulge in the right lower abdomen, which is caused by the limitation of the inflammation by the surrounding structures (e.g. intestinal loops or organ hinges). In such a case, treatment takes place during hospitalization, consisting of intravenous administration of antibiotics, dietary measures and monitoring of the clinical condition. In the case of the development of an abscess, i.e. a cavity filled with pus, drainage is performed, which is the introduction of a thin plastic tube through the abdominal wall into the abscess under CT or sonographic control, or small abscesses can also be treated conservatively with antibiotics," says MUDr. Silvia Jaroščiaková from FN Motol.

Convalescence: forget about sports and chocolate for a while

Thanks to the fact that the operation is quite simple, the patient usually only stays in the hospital for a few days, but of course it depends on the post-operative condition and how extensive the inflammation was .

"If there has already been a perforation of the inflamed appendix and the transition of the inflammation to the peritoneum, treatment requires prolonged administration of antibiotics intravenously and sometimes hospitalization in the intensive care unit," adds MUDr. Pastor.

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After a week to ten days after the operation, stitches are removed as standard. Afterwards, it is advisable to lubricate and massage the scars. In total, wounds usually take six to eight weeks to heal. That's why calmness is important. If you expect that the child can immediately jump into sports activities, you need to slow down, otherwise there is a risk that a hernia will form in the scar. The child should remain at rest for at least two to three weeks. After three weeks, the patient can attend school with a limitation of six weeks without physical education, according to the primary teacher Karel Harvánek.

Will a diet be necessary?

A so-called saving diet for three to six months is also associated with the rest regime. "This is a diet with less residue, and above all, a non-bloating diet. Every patient after an appendectomy is provided with a text with this diet when they are discharged from the hospital," says MUDr. Harvánek.

In addition to a flatulent diet, according to doctor Jarošciaková, food that causes constipation, such as chocolate, is also dangerous. So, even if it seems unpleasant, it is definitely recommended to follow these principles during recovery so that the child jumps back into normal life as soon as possible.