A young child arrives at the emergency room after several days of abdominal pain, vomiting, and diarrhea and is sent home with a diagnosis of viral gastritis and treatment for the symptoms. The child seems better for a while, only to return to the ER with worse symptoms and a ruptured appendix, a life-threatening complication of appendicitis.
The scenario is not uncommon, experts say, because children with appendicitis don't usually have the classic symptoms of the condition, but pediatricians at the Johns Hopkins Children's Center say there are ways for doctors and parents to tell the difference early on between a potentially deadly burst appendix — which can kill in a matter of days, even hours — and a stomach bug.
Past research has found that half of appendicitis cases are misdiagnosed when they first present at the emergency room or the doctor's office and that up to 80 percent of appendicitis cases in children younger than 4 years of age end up in rupture.
Says emergency room pediatrician Jennifer Anders, M.D., of Hopkins Children's, who has seen her fair share of burst appendixes, "appendicitis should always be near the top of the list of potential culprits when a child has any abdominal pain, vomiting, and malaise," keeping in mind that many children don't have fever or lose appetite the way adults might.
Doctors recommend that children with prolonged or severe abdominal symptoms that do not go away or improve should be evaluated for ruptured appendix. Consider the following questions:
- Do blood tests indicate elevated white cell count?
- Does the child have diarrhea? Diarrhea, which can be a marker of bowel inflammation resulting from the infection caused by the burst appendix, often distracts doctors and puts them on a different track. Diarrhea may not be a classic sign of appendicitis, but it may signal a ruptured appendix.
- Did the child have vomiting, which later stopped?
- Was there sharp pain in the lower right portion of the abdomen, which later subsided and became dull and spread across the abdominal area? Paradoxically, as appendicitis worsens and the appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.
"It's counter-intuitive, but if that sharp pain improves or subsides and becomes more generalized, it's actually a bad sign," Anders says.
The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix before they reach the OR.
Source: Johns Hopkins Medical Institutions
Related stories:
Does this child have appendicitis? Watch out for key signs
A 5-year-old with abdominal pain, nausea and fever may have appendicitis or any of a number of other problems. But how does the child’s doctor decide whether to schedule an emergency appendectomy to surgically remove a presumably inflamed appendix — a procedure that carries its own risks like any surgery — or wait and observe what could be a ticking time bomb that could rupture and kill the patient in a matter of hours?
Surgeons perform world's first pediatric robotic bladder reconstruction
A 10-year-old Chicago girl born with an abnormally small bladder that made her incontinent has become the first patient to benefit from a new robotic-assisted bladder-reconstruction method developed by surgeons at the University of Chicago Medical Center.
Heterotopic gastric tissue simulating acute appendicitis
It is not uncommon to find tissue that normally lines the stomach in locations outside of the digestive tract. This "heterotopic" gastric tissue has been identified in such diverse locations as the scrotum, the gall bladder, and the spinal cord.
Schizophrenics more likely to suffer from ruptured appendix
People with mental illness suffer more than just psychological problems. People with schizophrenia are more likely to suffer from ruptured appendix than others, according to research published in the online open access journal, BMC Public Health.
Appendix isn't useless at all: It's a safe house for bacteria
Long denigrated as vestigial or useless, the appendix now appears to have a reason to be – as a “safe house” for the beneficial bacteria living in the human gut.
It's your surgeon's turn to say 'open wide'
Dr. Christopher Gostout remembers the first time he heard anyone suggest such a thing. He was in a roomful of doctors at a seaside resort, brainstorming about the future. Perform surgery without piercing the skin? Take out someone's appendix through the mouth?
FoxJ1 helps cilia beat a path to asymmetry
New work at the Salk Institute for Biological Studies reveals how a genetic switch, known as FoxJ1, helps developing embryos tell their left from their right. While at first glance the right and left sides of our bodies are identical to each other, this symmetry is only skin-deep. Below the surface, some of our internal organs are shifted sideways—heart and stomach to the left, liver and appendix to the right.
Glazed America: Anthropologist examines doughnut as symbol of consumer culture
Few things say as much about our culture as the food we eat. A new book, Glazed America: A History of the Doughnut by Paul R. Mullins, Ph.D., an Indiana University-Purdue University Indianapolis anthropologist, explores the development of America's consumer culture through our relationship with the doughnut, beloved by many, a symbol of temptation and unhealthiness to others.