Appendicitis is an inflammation of the appendix, which is a small pouch or finger-like projection at the beginning of the colon (large intestine) in the lower abdomen. The condition is more common in young people aged 11 to 20 years and one of the most common causes of emergency abdominal surgery. Male teens with a positive family history may have an increased risk for appendicitis (1).
Read this MomJunction post to know more about the causes, symptoms, complications, diagnosis, and treatment of appendicitis in teens.
Signs And Symptoms Of Appendicitis In Teenagers
The signs and symptoms of appendicitis in teens include (2):
- Abdominal pain due to appendicitis usually begins suddenly in the middle of the tummy, that is around the naval area, and later moves down to the lower right part of the abdomen. The pain usually exacerbates while coughing or walking.
- A low-grade fever follows the abdominal pain and may worsen over time.
- Lack of appetite
- Diarrhea or constipation
- Abdominal gases (flatulence) and bloating
- Urinary symptoms such as urgency and frequency
- Respiratory symptoms such as shortness of breath
Appendicitis pain can come and go in the beginning when it is felt around the middle of the abdomen. The pain becomes constant and severe after shifting to the lower right abdomen within hours (2). Chronic appendicitis may show only abdominal pain, and other appendicitis symptoms may not be evident.
Teenage girls may have appendicitis-like pelvic pain due to some gynecologic disorders. The presence of vaginal bleeding or vaginal discharge may help exclude the possibility of appendicitis.
When To See A Doctor
Seek immediate medical care if your teen has pain starting from the middle of the tummy and spreading to the right lower part of the abdomen. Avoid giving them food, drinks, or painkillers before consulting a doctor. Early medical attention can be helpful to confirm the diagnosis and begin treatment promptly.
Diagnosis Of Appendicitis In Teens
The doctor may examine the child by applying gentle pressure on the abdomen or moving legs to identify the location of the pain. Teenage girls may require a pelvic exam to rule out gynecologic causes of pain on the right side of the abdomen.
The following tests may be ordered to confirm the diagnosis of suspected appendicitis (3).
- Blood tests: It may give evidence of infection such as increased white blood cell count, or C-reactive proteins (CRP).
- Urinalysis: Urine tests are often performed to exclude kidney stones and urinary tract infections that cause lower abdominal pain.
- Imaging tests: Abdominal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or an X-ray of the abdomen can be performed to visualize the appendix.
Urological diseases, such as kidney stones and pyelonephritis, mimic appendicitis in some cases. Gastrointestinal diseases such as ulcerative colitis and Meckel’s diverticulitis may also show symptoms similar to appendicitis.
Genital diseases such as pelvic inflammatory disease, ovarian torsion, ectopic pregnancy in teen girls, and testicular torsion in boys may all present the same problems as seen in appendicitis (4). Your doctor may order a few additional tests to rule out other conditions and confirm the diagnosis of appendicitis.
Appendicitis Treatment In Teens
Surgical removal is the usual treatment for acute or chronic appendicitis. The following are key points about the treatment of appendicitis in teens.
- Surgical removal of the appendix is called an appendectomy, which can be done through laparoscopic (minimally invasive) surgery or laparotomy (open surgery).
- Laparoscopic appendectomy is less painful and allows for faster recovery. However, it may not be possible in teens with obesity or in cases of peritonitis, abscess, and appendix rupture. Open appendectomy allows washing of the abdominal cavity in cases of rupture (5).
- In a few cases, after imaging tests, if the risk of complications is not seen, then the surgeons may recommend antibiotic treatment and plan appendectomy later. However, treatment decisions and recovery depend on risks and complications.
- Abscesses are often treated with antibiotics with or without draining, and appendectomy is done after controlling the infection.
It is important to seek medical care on time. Early intervention may help in faster recovery –within two to three days of hospitalization. Rupture of the appendix may require more days of hospitalization and could increase the risk of surgical complications (1).
Lifestyle Changes For Teens After Appendectomy
The following lifestyle modifications and home remedies can be useful in post-appendectomy days (6).
- Take medications on time: You should give pain relievers and other medications as per prescription. If your teen still has pain or other symptoms, then call the doctor .
- Plan the diet: Your teen may require small portions of frequent meals initially. Also, encourage them to drink plenty of water to avoid constipation. Drinking alcohol should be avoided since it may interfere with medications. Avoid caffeinated drinks as they may cause constipation.
- Avoid strenuous activities: Always seek the doctor’s advice to return to regular physical activities after surgery. The teen should also avoid strenuous activities, such as lifting groceries, moving furniture, lifting children, etc., for around six weeks. Walking is one of the exercises allowed before six weeks of surgery. The teen may walk and climb stairs in moderation as per the doctor’s advice.
- Do not drive: It is advised not to drive until the first postoperative visit.
- Support abdomen while coughing: Placing a pillow on the abdomen and applying a little pressure could help reduce pain while coughing or laughing.
- Take rest: You may encourage your teen to take rest and sleep well after surgery to enhance the healing of wounds.
Call the doctor immediately if your teen has a fever, increased pain, redness, and swelling at the site of surgery.
Once the surgical wound and the intestines have healed, the teen can return to their normal eating and exercise routine.
Causes Of Appendicitis In Teenagers
Inflammation of the appendix can be caused by its obstruction. Obstruction or blockage of the appendix can be caused by (7):
- Lymphadenitis (inflammation of the lymph nodes)
- Intestinal worms
- Foreign bodies
- Bezoars (collection of indigestible materials in the digestive tract)
- Hardened fecal matter
- Trauma to abdomen
Obstruction may lead to infection due to bacterial growth and result in the accumulation of pus inside the appendix. If left untreated, it can lead to the rupture of the appendix.
Types Of Appendicitis In Teens
Teens can have any of the following types of appendicitis (8).
- Acute appendicitis: This is an acute inflammation of the appendix with sudden onset of symptoms. It is more common and requires immediate treatment.
- Chronic appendicitis: Chronic inflammation of the appendix may show mild symptoms and often comes and goes. The pain can be severe or dull, and these episodes can be recurrent.
Risks And Complications Of Appendicitis In Teens
Untreated appendicitis may result in complications including (9):
- Rupture: Inflamed appendix may result in rupture or perforation around 36 to 72 hours after the onset of symptoms. A few children may have a small rupture, while some may have spillage of a large amount of pus and feces into the abdominal cavity (10). It can be fatal and will require emergency surgery for the removal of the appendix and cleaning of the abdominal cavity.
- Peritonitis: This may happen after the rupture of the appendix. In this condition, the peritoneum (lining of the abdominal wall) gets infected from the infected contents of the appendix. Peritonitis can be associated with severe pain, rebound tenderness, shortness of breath, rapid heartbeat, and high fever.
- Appendicular abscess: This is the collection of pus in the abdomen and the most common complication of acute appendicitis. The pus requires surgical draining with tubes and treatment with antibiotics.
How To Prevent Appendicitis?
There is no proven way to prevent appendicitis (11).
Some studies show that a high fiber diet may reduce the risk for appendicitis. It is noted that the occurrence of the condition is low in countries where people consume fiber-rich foods, such as fruits and vegetables. However, more studies are needed to prove the effectiveness of high fiber foods in the prevention of appendicitis (1).
Some home remedies, such as consuming garlic, ginger tea, mint, etc., are followed by people, but they have not been scientifically proven to cure appendicitis. Giving oil massages or applying heat on the abdomen is not recommended by experts.
Appendicitis can be completely cured with the removal of the appendix. Pain relievers and antibiotics should not be given to your teen without doctors’ examination. Sometimes, chronic appendicitis pain episodes can be recurrent and may cause complications if left untreated. Therefore, it is best to promptly see a doctor when your teen complains of sharp and severe abdominal pain.
2. Symptoms; Appendicitis; The National Health Service
3. Matthew J. Snyder, et al.; Acute Appendicitis: Efficient Diagnosis and Management; The American Academy of Family Physicians
4. Joel P. Thompson, et al.; Mimickers of Acute Appendicitis; Journal of The American Osteopathic College of Radiology
5. Treatment for Appendicitis; The National Institute of Diabetes and Digestive and Kidney Diseases
6. Caring for myself after Laparoscopic Appendectomy; Michigan Medicine; University of Michigan
7. Symptoms & Causes of Appendicitis; The National Institute of Diabetes and Digestive and Kidney Diseases
8. A. L. van den Boom, et al.; Interobserver variability in the classification of appendicitis during laparoscopy; British Journal of Surgery
9. Complications; Appendicitis; The National Health Service
10. Ruptured Appendicitis; The American Pediatric Surgical Association
11. Appendicitis; Johns Hopkins Medicine
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