Appendicitis can be a side-splitting and serious pain

“He was doubling over in pain and would cry out if you touched his lower belly."

Desireé and Randy Daniels, of Taylorsville, Ky., are busy parents with two young kids. Desireé also happens to be an emergency department nurse, which gives her an advantage when it comes to taking care of sick children. But in January of this year, just two weeks after their oldest son’s birthday, 6-year-old Keegan became seriously ill with what would later be diagnosed as acute appendicitis.

“He was doubling over in pain and would cry out if you touched his lower belly,” Desireé said. “He just wasn’t himself and I knew there was something potentially serious going on.”

Desireé took their son to his pediatrician, who suggested that it might be a form of a nasty stomach virus that had been going around and to keep an eye on him for a while. It is very important to note here that diagnosing appendicitis, especially in children, can be tricky. Often, appendicitis and gastroenteritis are confused with one another.

That night, after no change in Keegan’s condition, Desireé took him to a local emergency department, where a computed tomography (CT) scan of his abdomen revealed a potential blockage with no specific cause. He was discharged home with medications in the hopes that the blockage would resolve. A day and a half later, after no improvement with the medication, Desireé and Randy took Keegan to the Norton Children’s Hospital emergency department. The immediate diagnosis was appendicitis and surgery was scheduled for that afternoon. Approximately 15 minutes into surgery, Desireé and Randy were called by the surgeon and told Keegan’s appendix had ruptured.

The appendix is a small, closed tube about the size and shape of a pinky finger attached to the beginning of the large intestine where it connects with the small intestine. Removing the appendix becomes necessary when the opening of the appendix becomes blocked, causing it to swell and become inflamed. This is called appendicitis. About 450 appendectomies, removal of the appendix, are performed each year at Norton Children’s Hospital.

“One of the most common general surgeries we perform at Norton Children’s Hospital is appendectomy,” said Chad A. Wiesenauer, M.D., pediatric surgeon at Norton Children’s Hospital and assistant professor of surgery at University of Louisville School of Medicine. “However, appendicitis can be difficult to diagnose. This is particularly true in children younger than age 7, in whom the symptoms of gastroenteritis and constipation are often identical to the symptoms of the much more serious appendicitis.”

Most appendectomies at Norton Chidren’s Hospital are performed laparoscopically, via very small incisions and the aid of a tiny video camera.

“When performing surgery, it’s always our goal to be as minimally invasive as possible,” Dr. Wiesenauer said.

According to Dr. Wiesenauer, a common misconception is that once appendicitis has been diagnosed, and even in some cases like Keegan’s in which the appendix has ruptured, the patient must be rushed into surgery to remove it.

“Once we have confirmed or highly suspect appendicitis, we start intravenous antibiotics to stop its progression and administer fluids to children who show signs of dehydration. This prepares the young patient physically for the operation, and the general anesthetic necessary to perform it, with as low a complication rate as possible. The scientific literature has proven that emergency appendectomy does not benefit the patient in any way. In Keegan’s case, even though it had ruptured, we were able to remove it successfully in a nonemergency surgical setting,” Dr. Wiesenauer said.

Desireé knew her son was in the best care possible under Dr. Wiesenauer’s direction at Norton Children’s Hospital.

“While no one wants to be in a hospital with a young child, especially when it involves surgery, I have to say our experience was fabulous,” Desireé said.

Keegan may remember how bad his tummy hurt and the tiny scars he has to show his friends and family, but his mom and dad will remember how everyone at Norton Children’s Hospital treated them like members of their own family.

“Everyone from Dr. Wiesenauer to Keegan’s lead nurse to the people who brought meals to the person who cleaned his room was so kind and helpful, asking us if we were OK or needed anything,” Desireé said. “It really makes a huge difference when you’re going through something serious with your child. As a nurse I know this, but at that time and moment, we were parents worrying about our baby boy who was having an operation.”

For Keegan, removal of his appendix probably wasn’t the present he was hoping for right after his sixth birthday. But it hasn’t slowed him down. He loves rock climbing and doing just about anything outdoors with his dad. He also enjoys video games and playing with his 2-year-old sister, Riley.

While Dr. Wiesenauer points out an important misconception about emergency appendectomies, he says it’s equally important to pay close attention to how and where your child describes abdominal pain.

“Appendicitis is a very serious medical condition and, when undiagnosed and untreated, can be life threatening,” he said.

He outlines a few telltale signs and symptoms to look for that may help identify if your child has appendicitis:

  • Pain that begins near the belly button and moves to the right side
  • Decrease in appetite accompanied by nausea and vomiting
  • Mid-grade fever

If your child experiences these symptoms, call his or her pediatrician or other health care provider.


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