Belly Pain- Is it an Appendix?

A common reason for parents to bring their kids to the ED is belly pain.  Doctor’s offices and “quick care” urgent care clinics also send us a lot of kids with belly pain.  Everyone has the same  basic concern- is it appendicitis?  Does the child need an operation? I often encourage families to stay home or wait to see their doctor for things that are obviously not emergencies.  Runny noses, fevers, diarrhea, rashes, even ear pain- Stay home!  Give ibuprofen!  Belly pain, though, should not be waited on very long.  Belly pain lasting more than a few hours needs to be discussed with a doctor, first on the phone, and then in the office or E.D. What is appendicitis?  The appendix is a tiny pouch that usually hangs off your intestines in your right lower side.  Appendicitis is when poop gets trapped in the appendix, gets infected, and the appendix slowly swells like a boil.  With swelling and infection comes pain, fever, and nausea.  A “ruptured” appendix is when the appendix bursts and the pus and infection spread throughout the abdomen.  We always hope to diagnose appendicitis and get it out before rupture, but that is sometimes just not possible. Though most belly pains turn out to be stomach virus or constipation, the diagnosis of appendicitis can be tricky.   Early on appendicitis can act like stomach virus and fool the doctor.  Sometimes the child is admitted to the hospital, the doctors and surgeons debate and ponder, and finally days later the surgeon decides to take the patient to surgery for the pain.  Only then, with the patient opened up, does the surgeon look in and go “ah-ha” and make the diagnosis. With belly pain, first call your doctor.  Some doctors are comfortable making the diagnosis in the office and then sending the patient right to a surgeon.  Some refer the family to the ED for diagnosis.  Make sure you take your child to a hospital that cares for children and has surgeons available.  In Lafayette, that is Lafayette General Medical Center and usually Women’s and Children’s Hospital too. What does a child with appendicitis look like?  First, the pain starts as a steady, slowly worsening pain.  Often the pain starts in the middle of the belly, under the belly  button, and later is more in the right lower side.  Kids with appendicitis lose their appetite and sometimes vomit later in the illness.  They also often have later fevers.  This is usually unlike stomach virus, where kids vomit first, have early fevers, and have crampy belly pain that comes and goes away. At the hospital, the ED doctor and surgeon often make the diagnosis and decide on surgery by just taking a history (hearing the “story” of the illness) and examining the child.  Few tests are needed besides a few blood tests.  CT scanning is usually unnecessary.  One estimate is that only 10% of appendicitis cases need a CT to make the diagnosis.  CT adds a lot of radiation exposure, and sometimes can miss an appendicitis or mislead the doctors with extraneous information. The surgery itself is usually uncomplicated and safe, as long as the appendix hasn’t ruptured.  The child often goes home in a day or two after surgery.  If the appendix has ruptured, that means recovery takes a week or two of antibiotics and care in the hospital. So if your child has belly pain, but is walking, smiling, eating and the pain goes away soon, it probably is not appendicitis.  If he or she starts with pain that is steady and worsening over some hours, come on in!