A child's sharp bellyache could be appendicitis

By Bettina Levecke Sep 6, 2010, 4:06 GMT

Hamburg - Children often have bellyaches. The causes, such as gas, are usually harmless. But a sudden pain that intensifies could indicate an inflamed appendix, or appendicitis, which occurs most frequently in childhood and adolescence.

The appendix is a blind-ended, finger-shaped tube projecting from the caecum, the pouch that is the beginning of the large intestine. It has no known function. The cause of inflammation is usually unclear. Fecal matter can become trapped in the appendix, promoting growth of bacteria. Intestinal parasites or a constriction in the caecum are other possible causes.

Swallowing fruit seeds is not a risk factor, however. 'Melon seeds, cherry stones and grape seeds don't lead to appendicitis as widely believed,' said Wolfram Hartmann, president of Germany's Professional Association of Children's and Young People's Physicians.

A child with appendicitis may have a fever, nausea and feeling of general unwellness, said Tim Niehues, director of the Centre for Children's and Young People's Medicine at Helios Clinic in the German city of Krefeld.

'Parents should by all means take the child to a doctor to clear up their suspicion,' Niehues advised. In many cases the pain shifts to the lower right area of the abdomen, which he said was 'extremely tender - the child complains of pain when you apply pressure there.'

A fairly sure sign of appendicitis, Niehues said, is when a child no longer feels capable of bending his or her right leg or jumping down from a chair, or who complains of pain while doing so.

A child suspected of having appendicitis is often admitted as an inpatient at a hospital or children's clinic but not operated on immediately.

'Often the child is given an enema first, then observed for a few hours to see how the pain develops,' Hartmann said. In nearly half of all cases, the pain goes away by itself. For the others, the appendix must be surgically removed, a procedure known as an appendectomy.

'When in doubt, take it out,' said Phillip Szavay, head physician at Tuebingen University Hospital's department of paediatric surgery. 'If we don't take out an inflamed appendix, we put the patient's health at risk.'

If an inflamed appendix ruptures, pus and contents of the intestines can leak into the abdominal cavity. Then, Niehues warned, 'life-threatening sepsis occurs within a short time.' Once disease-causing bacteria enter the bloodstream, 'in the worst-case scenario it's too late for an operation.'