Appendicitis in Children: symptoms, causes, treatment and recovery

Dr Nada Sudhakaran

Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

Appendicitis Children

Appendicitis is a condition that affects a child’s appendix, a small, worm-shaped organ located on the right side of the abdomen. When the appendix becomes inflamed, it is known as appendicitis.

Common symptoms of an irritated appendix (appendicitis) in children include fever, nausea, vomiting, and painful swelling in the right lower abdomen. If left untreated, this can lead to an infected and ruptured appendix and cause serious illness or death.

Pediatric appendicitis is typically treated with emergency surgery to remove the appendix (appendectomy).

This article by Dr. Nada, a paediatric surgeon, based in Kuala Lumpur, Malaysia, provides all of the information parents should be aware of regarding appendicitis in children.

What is appendicitis in children?

The appendix is a small, worm-shaped organ located on the right side of the abdomen. However, in some cases, it can be found in other areas of the abdominal cavity. It is attached to the large intestine by a thin tube of tissue called an ileocecal valve. The role of a child’s appendix has not been clearly understood by medical experts; however, it has been thought that some bacteria that aid with food digestion are stored there when needed for use in the intestines.

Source: http://www.myhealth.gov.my/en/acute-appendicitis/

When appendicitis occurs, it is caused by one or more blocked ducts within a child’s appendix. This makes it difficult for mucus and pus to drain from inside the appendix, causing increased pressure and irritation within this small organ. The blockage then leads to increased activity of the cells in the wall of the infected appendix, which causes it to swell and put pressure on other abdominal organs.

Acute appendicitis can occur when a bacterial infection spreads inside the lining of the appendix, or when a foreign object becomes stuck inside the opening. This can cause an appendix to rupture and lead to what’s known as perforated appendicitis or ruptured appendicitis.

How common is appendicitis in children in Malaysia?

Appendicitis happens in about 7% of younger children globally, and it is the most common cause for emergency abdominal surgery among individuals under 18 years old.

In Malaysia, 10 to 20 Malaysians out of 100,000 will develop appendicitis every year. This means there are approximately 11 to 22 patients diagnosed with appendicitis daily.

Hello, I am Liloïa, I am 10 years old and two weeks ago I had my appendix taken out by DR Nada with keyhole surgery. This was on a Monday, it happened very quickly, only 4hours after arriving at ER I was going to surgery. On Tuesday, Dr Nada agreed to discharge me and sent me home.

After that my surgery recovered pretty well until a girl jumped on my wound from height 10days after surgery. My wound bleed and hurt but on the next day I had a big important athletics competition and Dr Nada gave me green light to go. I didn’t practice for 2months (had knee problem before), had that surgery 10days before and still managed to win 3 gold medals ? ??(400m, 200m and 100m relay against 7 other runners from different schools).

Thanks a lot Dr Nada for your help, for your amazing job, for being available and listening to me. I am very very grateful.

Marion Fages, mother

What are a child’s symptoms of appendicitis?

The common symptoms of appendicitis in most children can include:

  • a feeling of discomfort or painful swelling on the right side of the child’s abdomen, which becomes more severe as time passes.
  • a swollen belly, with sluggish bowel movement that may leave child constipated
  • fever and chills
  • loss of appetite, nausea, and vomiting
  • diarrhea (especially small amounts, with mucus)
  • lack of energy and weakness.

Appendicitis occurs 2 times more often in males than females. In some cases, young children may have atypical symptoms that mimic other illnesses such as gastroenteritis or urinary tract infection.

For this reason, it is important to be aware that there are different risk factors associated with appendicitis – one being a family history of the condition.

If you suspect your child has appendicitis, it is important to seek immediate medical attention. The sooner it’s caught, the easier it will be to treat.

How is appendicitis diagnosed?

While there are no specific tests for diagnosing appendicitis, your child’s healthcare provider may decide to perform a physical exam and various tests to rule out other conditions that can cause similar symptoms:

Blood tests and urine tests:

These will be done to check the health of the kidneys and liver while also checking for metabolic causes of pain such as urinary tract infection.

Abdominal x-rays:

A small test tube may be inserted into the nose or mouth and passed down towards the stomach, allowing your doctor to view images on a computer monitor. This allows them to look for blockages in other organs such as the colon and bladder. It may also allow them to see if there is a foreign object in the appendix.

Abdominal Ultrasound:

This is a painless test that uses sound waves and a computer screen to create images of organs inside the body, including the location of the appendix.

CT Scan

If your doctor suspects appendicitis may have ruptured, you will be referred for computed tomography (CT) scans or magnetic resonance imaging (MRI). These tests allow doctors to make an accurate diagnosis by using x-rays and computer technology.

Laparoscopic view of an inflamed swollen appendix

What are some complications associated with an infected and ruptured appendix?

The most common complication of appendicitis is a ruptured appendix; in fact, approximately 15 percent of people who are diagnosed with appendicitis will have their appendix burst within a few hours after diagnosis. The risk for this complication increases considerably if treatment is not received within 24 hours after symptoms have begun. If there is no ruptured appendix, patients usually experience relief from their pain within 5 days. However, 50% of patients will still develop complications during this time, such as peritonitis , a bacterial infection of the tissue surrounding the appendix.

What are the risks of not treating appendicitis?

Failure to diagnose appendicitis can lead to peritonitis, which is usually fatal if not treated immediately.

Acute appendicitis is a medical emergency and should be treated very seriously.

If an individual does not receive treatment within the first day of experiencing symptoms, a child’s risk is 25% that they will develop a bacterial infection called peritonitis. If they do not receive proper treatment within 24 hours after diagnosis, this rises to 60%. When the appendix ruptures during this time period, there is a 90% chance that peritonitis will occur.

Peritonitis can be life threatening if treatment is not received immediately. The infection spreads very quickly and antibiotics may need to be given intravenously. If peritonitis occurs, you should seek medical help immediately by going to the emergency room or calling an ambulance.

My son is 6 years old this year. Two weeks ago, 20/10/20, because of constant vomiting, I took him to the general clinic to see a doctor. The doctor diagnosed that he had eaten the wrong thing. The next day, he still vomited, had a stomachache and had a slight fever. He went to another clinic and said he had intestinal inflammation.

On the third day, he did not get better, so he took him to a pediatric specialist. The doctor said that he should go to the hospital for appendicitis. The doctor gave me DR.NADA’s phone number and letter of introduction to the hospital.

After seeing DR.NADA and doing ULTRASOUND in the hospital, he was diagnosed with appendicitis and ruptured. The doctor immediately ordered him to perform the operation at night. DR.NADA explained that the operation uses the laparoscopic method, which can alleviate the huge pain that the child must endure. The operation took about an hour and a half.

The next day, my son recovered well, the wound was small and he would not feel very painful. He was discharged after 5 days in the hospital.

Return to the clinic 1 week after discharge to allow DR.NADA to evaluate the child’s surgical wound and discuss the results of the appendix analysis sent to the laboratory.

Thank you very much for DR.NADA’s help, thank you for your excellent work. I am very, very grateful.

Yee C.P, mother

How is pediatric appendicitis treated?

In almost all cases, appendicitis is treated with surgery to remove the appendix. If the diagnosis is uncertain, you will be kept under observation for a few hours or days before surgery is performed if symptoms persist. During this time, your doctor may prescribe antibiotics to reduce the risk of infection and inflammation.

The majority of children who are diagnosed with appendicitis have their appendix removed without developing any further complications from the condition. In some cases, using pain medicine and antibiotics may be an option for those under 5 years old as long as there are no signs of peritonitis.

What are the post-operative risks?

Some of the potential risks of an appendectomy include infection, blockage of intestine, bowel problem, loss of blood supply to intestine, incomplete removal of the appendix (fistula), reopening of incision site during recovery period due to coughing or sneezing, leakage from incisions, injury to nearby organs, injury to colon or small intestine.

What are the pros and cons of having appendectomy surgery?

Pros of appendicitis surgery

There is a high chance that your child will only suffer abdominal pain if he/she has appendicitis. An inflamed appendix can rupture at any time which may cause the onset of a serious infection, so prompt surgery is essential to ensure your child’s health and well-being. The appendix can be removed using either a traditional incision method or a laparoscopic method which results in shorter hospital stay and less postoperative pain.

Cons of appendicitis surgery

An appendectomy may not relieve your child’s abdominal pain if they have another condition that mimics the symptoms of appendicitis such as pancreatitis, ovarian cysts, indigestion, pelvic inflammatory disease, irritable bowel syndrome (IBS), gastroenteritis.

What are the different types of surgery (appendectomy) available for children?

Surgery of the appendix is known as an Appendectomy. There are two main types of surgery for appendicitis: laparoscopic surgery and open surgery.

Laparoscopic Appendectomy:

This procedure, also known as keyhole surgery, is becoming the most common method as it does not require an abdominal incision and therefore reduces recovery time and shortens hospital stays. Patients generally experience less pain after the surgery, and the rate of post-surgical complications is also lower than with open appendectomies.

Open Appendectomy:

In this procedure, a small horizontal incision around 2-4 cm long is made on the patient’s right side. The appendix is then removed through this opening.

Open surgeries typically take longer to perform than laparoscopic procedures and require children to stay in the hospital longer for recovery.

This type of surgery will typically involve a much larger incision than laparoscopic procedures, which increases the risk for some complications occurring.

Though there is a large incision, the visibility to the structures inside the abdomen is limited. This is especially important when the appendix is burst as the pus within the abdomen cannot be visualised and cleared completely and increases the risk of abscess formation or wound infections and the need for a second surgery .

Patients who have undergone this type of operation may experience pain during bowel movements for several weeks after surgery, but these symptoms normally go away within 6 months.

How is Laparoscopic Appendectomy performed?

Laparoscopic appendectomy is usually done on an outpatient basis (without an overnight stay in the hospital). Your surgeon will make several very small incisions in your abdomen through which a laparoscope and surgical tools are inserted. The appendix is located, removed, and inspected to make sure it is healthy. Finally, the incisions are closed with sutures (stitches) or staples.

Surgery can take anything from 30 minutes to about 2 hours depending in how advanced the appendicitis is or how “stuck” the appendix may be. If there is pus in the tummy, samples are taken and sent for analysis, so that the antibiotics therapy subsequently can be targeted for the bacteria that’s found in the pus. The appendix that’s removed will also be sent to the laboratory for analysis.

How is an Open Appendectomy performed?

An open appendectomy involves making a horizontal incision about 4 cm in length on the right side of the abdomen. The appendix is then removed through this opening, and the wound is closed with stitches or surgical staples

What are some potential risks involved with an open appendectomy?

This type of surgery will typically take longer than laparoscopic procedures, which increases the risk for complications occurring. There is also a higher chance that it will be difficult to diagnose other conditions due to scar tissue from the previous surgery. Patients who have undergone this type of operation may experience pain or bleeding during bowel movements for several weeks after surgery, but these symptoms normally go away within 6 months.

What should I expect after my child has had an appendectomy?

On completion of surgery your child will be sent to the recovery area where you can meet them. Regardless of whether you child has laparoscopic or open appendectomy, they will likely be very tired after surgery because it takes much longer for young children to wake up from anesthesia than adults due to their slower metabolism rate. If possible, you should try not to move your child around too much during the first 24 hours after surgery. This helps reduce their discomfort and avoids accidentally pulling out any stitches that are in place after the operation.

Usually your surgeon will discuss with you what was found at surgery and the subsequent plans post-surgery. A mildly inflamed appendix without any pus in the tummy will recover quickly following surgery and may even be discharged the following day, however more complex situation may take a little longer in the hospital.

Once discharged they are back to their normal functioning in about 3 – 4 days with the keyhole technique, compared to over 1 week with the open operation. A follow up appointment is usually made 1 week after surgery to enable your surgeon to assess your child’s surgical wound and to discuss the results from the sample of appendix sent to the laboratory. After this there is usually no need for further follow up with your child’s healthcare provided for this.

On 24th July 2019 while I was living in Kuala Lumpur with my beloved family for my work, I took my 8 years old son, Hafiz Maulvi Abdul Malik to clinic in Kuala Lumpur for checking up his abdominal pain.

It was 3 days that my boy had been having a bad cold, vomiting, loss of appetite and gradually stomach illness that left him unable to walk. Based on clinic’s doctor observation my boy had suspect symptoms of appendicitis, so the doctor suggested me to straight away send him to Prince Court Medical Centre for further treatment.

Once abdominal ultrasound scan done, he was diagnosed with appendicitis and a ruptured case at that. The doctor recommended me to see Dr Nada who is a Paediatric Surgeon and Urology specialist in Prince Court Medical Centre. After seeing Dr Nada, the surgery decision shall be conducted immediately at that time to avoid the severe condition on my boy since he was feeling severe pain in his stomach which become sharper even if he didn’t move his body.

Finally, Dr Nada undertook keyhole surgery and did excellent work on my boy. It took longer time (more than 2 hours) that allowed for washing and cleaning up inside of my boy’s abdomen due the pus has spread up to his liver. After successful completion of surgery, the condition of my little boy began to gradually improve well. The result of surgery by the ‘keyhole’ technique that looked like the wound was very small and painless of post-surgery.

After the surgery, Dr. Nada frequently visited to take care of my boy and gave him an intravenous antibiotics treatment that targeted for bacteria due to spreading of pus. My little boy was discharged and went home in 5 days later.

Now Hafiz is in good health and cheerful. Alhamdulillah, I’m very grateful and thank you Dr Nada for all your help.

Puthut Kariwibowo, father

How long before my child can return home?

Most children recover quickly and are able to go back to school at least a week after having an appendectomy. They should not engage in any physical activity or be involved in strenuous activities until they have discussed this with their doctor.

How to prevent appendicitis in children?

General medical practice recommends children to receive the H. influenzae type b (Hib) vaccine, pneumococcal vaccine, and the then-optional hepatitis B vaccine in infancy, followed by boosters throughout preschool years, at age 11–12 before starting school, around 13 years old when they are in middle school or junior high school, between 16–18 years of age when in high school.

Antibiotics can be used to treat mild cases of appendicitis. However if antibiotics do not work within a day or two after taking them, surgery is usually necessary to remove the appendix.


Appendicitis is a common surgical emergency in children. If left untreated, appendicitis can cause peritonitis (an inflammation of the lining of the abdomen) with abdominal pain that worsens over time. Though appendicitis is rare, it should be treated as an e emergency situation parents and medical professionals alike to avoid complications. Delayed surgery may even result in death.

Treatment for appendicitis includes surgery to remove part or all of your child’s appendix where there are no other complications. After treatment for appendicitis, most patients recover quickly without any long-term effects on their health.

As a reminder, here are some tips for you to remember when your child has tummy pain.

Best to take your child to see a doctor General Practitioner (GP) for a start or to the emergency department at a hospital ( preferably one with a Paediatric Surgeon):

  1. Constant, persistent abdominal pain that lasts more than 2 hours, without relief.
  2. Diarrhoea lasting more than 24 hours, particularly with associated lower abdominal pain.
  3. Tummy pain with vomiting, especially when the vomitus is green or blood stained.
  4. Tummy pain with blood in your child’s faeces.
  5. A younger child who prefers to lie still, refuses to be cuddled, wants to be left untouched.

Remember, if your child is diagnosed to have appendicitis, do ask for a Paediatric Surgeon and preferably one who performs laparoscopic or keyhole surgery.

If you visit Emergencies at Pantai hospital or Glenagles hospital (Kuala Lumpur) you can ask the on-call doctor to refer you to Dr Nada.

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Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

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