JAMA PEDIATRICS PATIENT PAGE

New Approaches for Appendicitis in Children

Appendicitis is defined as inflammation of the appendix, which is a small section
of the intestine that sticks out where the small and large intestines come together
(similar to a dead-end side street in the intestines).

Appendicitis happens when the appendix gets blocked with a

particle in the stool and then becomes inflamed. The blockage can
cause bacteria to overgrow in the appendix, leading to infection
and inflammation. Appendicitis is a common condition in childhood
and typically occurs after age 10 years, although it can occur at any
age. Appendicitis is the most common disease leading to surgery
in children.
Children with appendicitis usually have abdominal pain that may
begin in the middle of the abdomen and later become most painful
in the lower right areas of the abdomen, where the appendix is
located. They often have a fever, as well as vomiting, nausea, and
loss of appetite. Compared with viral illnesses that can also include
these symptoms, appendicitis symptoms typically get worse over
time to the point in which a child may refuse to eat or avoid moving
because of the abdominal pain. If you are concerned about
appendicitis, call your pediatrician.
New research and clinical updates have led to changes in how
appendicitis is diagnosed and treated. In the past, appendicitis was
commonly diagnosed with a computed tomography scan. How-
ever, it is now common to use ultrasonography to help with
diagnosing. This approach can help avoid the radiation and risks
that are associated with computed tomography scans. For more in-
antibiotics either before, or instead of, surgery to treat appendici-
formation about radiation risks for kids, see the Advice for Patients
tis.In some cases, such as perforated appendicitis, treatment can
article “Decreasing Unnecessary Radiation Exposure for Children”
involve an “interval appendectomy.” This treatment involves an
(http://jamanetwork.com/journals/jamapediatrics/fullarticle
initial antibiotic treatment and then a return for an appendectomy.
/384539).
Nonoperative treatment for appendectomy has been shown to be
Further, a diagnosis of appendicitis used to mean that surgery
as effective as surgery in up to 90% of children.
was almost guaranteed, but now additional treatment options may
be possible. Instead of surgery using an “open appendectomy,” in
which a surgeon removes the appendix through an incision in the
abdomen, the more common approach for surgery is laparoscopic, FOR MORE INFORMATION
which allows surgeries to take place using instruments that are American College of Surgeons
inserted through tiny incisions. Laparoscopic approaches typically https://www.facs.org/~/media/files/education/patient%20ed/app
have a lower risk of infections and complications, as well as better .ashx
pain control after the surgery and faster recovery.
To find this and other JAMA Pediatrics Patient Pages, go to the
Another change in the treatment of appendicitis is the involve- For Patients collection at
ment of antibiotics. Because appendicitis is typically associated with jamanetworkpatientpages.com.
bacteria trapped in the blocked appendix, some physicians use

Author: Megan A. Moreno, MD, MSEd, MPH
Published Online: September 5, 2017. doi:10.1001/jamapediatrics.2017.2935
Conflict of Interest Disclosures: None reported.
The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The
information and recommendations appearing on this page are appropriate in most
instances, but they are not a substitute for medical diagnosis. For specific information
concerning your child’s medical condition, JAMA Pediatrics suggests that you consult
your child’s physician. This page may be photocopied noncommercially by physicians
and other health care professionals to share with patients. To purchase bulk reprints,
call 312/464-0776.

1132 JAMA Pediatrics November 2017 Volume 171, Number 11 (Reprinted) jamapediatrics.com

© 2017 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ on 11/03/2019