Appendicitis

Learn symptoms, causes, management of paediatric appendicitis, and when to contact a paediatric surgeon in Singapore.

What Is Appendicitis?

Appendicitis is inflammation and infection of the appendix - a small, finger-shaped pouch attached to the large intestine in the lower right abdomen. When the appendix becomes blocked and infected, it swells and fills with pus. This is a medical emergency requiring immediate acute appendicitis diagnosis and treatment.
The appendix has no known essential function in the body, but when it becomes inflamed, it can cause serious complications if not treated quickly. Appendicitis most commonly occurs in children between the ages of 10-18, but it can happen at any age, including infants and toddlers.
Appendicitis emergencies require immediate recognition and treatment, because the inflamed appendix can burst (rupture or perforate), spreading infection throughout the abdomen. This is why quick acute appendicitis diagnosis and paediatric appendectomy surgery are crucial for the best outcomes.

Gastroschisis

Gastroschisis is a condition where there's an opening in the abdominal wall, usually to the right of the belly button. The intestines and sometimes other organs push through this hole and float freely in the amniotic fluid during pregnancy. There's no protective sac covering the organs, and they're exposed to the fluid throughout pregnancy.
Gastroschisis neonatal surgery is needed immediately after birth to place the organs back inside the abdomen and close the opening. As the intestines have been exposed to amniotic fluid for months, they may be swollen, thickened, and not working normally at first.

Omphalocele

An omphalocele is different: abdominal organs (intestines, liver, and sometimes other organs) protrude through the belly button area, but they're covered by a thin protective membrane (sac). The organs develop outside the abdomen within this sac.
Omphaloceles range in size from small (containing just a loop of intestine) to large (containing most of the liver and intestines). Omphalocele closure requires careful surgical planning, and the timing depends on the size and associated conditions.

Both gastroschisis and omphalocele are diagnosed before birth on routine prenatal ultrasounds, allowing time to plan for delivery at a specialised centre where abdominal wall defect neonatal surgery expertise is available.

Common Symptoms of Appendicitis in Children

Symptoms can vary by age, and recognising the emergency signs in children is critical.

In Older Children

Older children (typically over age 5-6) can usually describe their symptoms:

Abdominal pain that starts around the belly button, then moves to the lower right side within hours
Pain gets worse with movement, coughing, or being touched
Loss of appetite - often completely refuses to eat
Nausea and vomiting after the pain starts
Fever usually develops
Can't find a comfortable position - may lie still with knees pulled up
Pain when walking - may walk bent over, holding the right side
Rebound tenderness - pain gets worse when pressure is released after pushing on the abdomen

In Younger Children and Toddlers

Young children can't describe pain location well, making acute appendicitis diagnosis more challenging:

Irritability and fussiness without an obvious reason
Crying more than usual, especially inconsolable crying
Refusing to eat or drink
Vomiting (may be the main symptom)
Diarrhoea in some cases
Abdominal swelling or distension
Guarding - protecting the belly by tensing muscles or pulling away when touched
Fever
Lethargy - less active than usual

In Infants

Appendicitis is rare in infants but can occur. Signs include:

Severe fussiness and inconsolable crying
Refusing all feeding
Vomiting
Swollen, tender abdomen
Fever
Lethargy or decreased responsiveness

Emergency Warning Signs of Rupture

If the appendix bursts, symptoms may temporarily improve (pain decreases), then worsen dramatically. Widespread abdominal pain may come with high fever (often over 39°C), rapid heart rate, rigid abdomen, severe illness appearance, and dehydration.
Call emergency services or go directly to the emergency room. Do not give pain medication, food, or drink until evaluated by a doctor, as this can mask symptoms needed for an acute appendicitis diagnosis. Early paediatric appendectomy surgery prevents dangerous complications.

What Causes Appendicitis in Children?

Appendicitis occurs when the appendix becomes blocked, leading to inflammation and infection.

How Blockage and Infection Occur

The appendix is a narrow, closed-ended tube. When the opening becomes blocked, bacteria multiply inside, pressure builds, and inflammation develops. Common causes of blockage include:

Faecal Material: The most common cause is hardened stool that gets stuck in the appendix opening. This blocks drainage and creates an environment for bacterial overgrowth.
Swollen Lymphoid Tissue: The appendix contains lymphoid tissue (similar to lymph nodes) that's part of the immune system. During infections like colds, stomach flu, or other illnesses, this tissue can swell and block the appendix opening. This is why appendicitis sometimes follows a viral illness.
Foreign Bodies: Rarely, small objects or undigested food particles (like seeds) can block the appendix.
Intestinal Worms: In areas where parasites are common, intestinal worms can block the appendix.
Tumours: Very rarely, tumours can cause blockage, but this is more common in adults than in children.

Once blocked, bacteria multiply rapidly inside the closed appendix. The appendix swells with pus, pressure increases, and the wall becomes inflamed. Without treatment through paediatric appendix removal surgery, the blood supply to the appendix wall becomes compromised, leading to tissue death and eventual rupture.

Risk Factors

While any child can develop appendicitis, certain factors may increase risk:

Age: Most common in older children, teens, and young adults, but can occur at any age.
Family history: Slight increase in risk if close relatives have had appendicitis, suggesting possible genetic factors.
Previous infections: Recent viral or bacterial illnesses may trigger lymphoid tissue swelling.
Diet: Low-fibre diets may contribute to harder stools that can block the appendix.
Seasonal variation: Some studies show slightly higher rates in summer months, possibly related to infections.
Certain medical conditions: Children with cystic fibrosis or inflammatory bowel disease may have an increased risk.

The key is recognising appendicitis emergency symptoms early and seeking immediate medical care for an acute appendicitis diagnosis.

Consequences of Abdominal Wall Defects

Appendicitis is a surgical emergency. Without immediate paediatric appendix removal surgery, serious and potentially life-threatening complications develop.

Appendix Rupture (Perforation)

The most serious complication is appendix rupture, where the infected appendix bursts, spilling bacteria and pus into the abdomen.
Without treatment, most appendices rupture within 36-72 hours after symptoms begin. In young children, rupture happens faster (sometimes within 24 hours) because their appendix wall is thinner. Consequences of rupture include:

Peritonitis (infection of the abdominal lining) causes severe illness, high fever, extreme pain, and risk of septic shock
Abscess formation - pockets of pus that form around the ruptured appendix
Intestinal obstruction from inflammation and scar tissue
Need for more complex surgery and longer hospital stay
Prolonged antibiotics - often IV antibiotics for a week or more
Possible complications, such as intestinal obstruction from scar tissue
Longer recovery - weeks instead of days

Sepsis and Critical Illness

Exposed organs lose heat rapidly. Newborns can't regulate temperature well to begin with, let alone with abdominal wall defects. Hypothermia causes metabolic problems, difficulty breathing, blood clotting issues, and increased stress on all body systems.

Intestinal Damage

Severe infection from ruptured appendicitis can lead to:

Septic shock requiring intensive care
Need for a breathing machine (ventilator)
Kidney failure requiring dialysis
Blood clotting problems
Extended hospital stay (weeks in ICU)
Long-term complications

When appendicitis is caught early through acute appendicitis diagnosis and treated immediately with paediatric appendectomy surgery, the surgery is straightforward, and recovery is quick, with excellent long-term outcomes.

How to Treat Appendicitis in Children

Appendicitis treatment is the surgical removal of the appendix. At The Little Surgery, we provide expert paediatric appendectomy surgery, including paediatric laparoscopic appendectomy and open appendix removal surgery, with availability for emergency cases.

Emergency Evaluation and Acute Appendicitis Diagnosis

When you arrive at the hospital with suspected appendicitis, we check for symptoms, including when the pain started, where it hurts, whether your child has vomited, appetite changes, and fever. Careful abdominal examination is done to check for tenderness in the right lower abdomen, rigidity, and signs that rupture has occurred.
Imaging, such as ultrasound and CT scans, can be done to visualise the inflamed appendix and show any fluid collections or abscesses.

Paediatric Appendectomy Surgery

Once the acute appendicitis diagnosis is confirmed, we start to give fluids, antibiotics, and medications. Surgery is performed as soon as possible, usually within hours of diagnosis. There are two surgical approaches for paediatric appendix removal.
Paediatric laparoscopic appendectomy is a minimally invasive approach. The appendix is removed through a few very small cuts in the abdomen, using a tiny camera and specialised instruments. The operation typically takes 30-60 minutes.
Open paediatric appendectomy is a more traditional approach used in certain complicated situations, such as when the appendix has ruptured or there is a severe infection. The appendix is removed through one larger incision in the lower abdomen. This surgery usually takes 45-90 minutes.
Both approaches effectively treat appendicitis, and the safer choice depends on the specific situation.

Recovery After Paediatric Appendectomy Surgery

Uncomplicated Appendicitis
Children with unruptured appendices usually stay in the hospital for 1-2 days after surgery, where they take pain medication, clear fluids, and light foods as needed. They can typically get up and walk the same day or the next morning.
At home, pain is mild and can be controlled with medication. Children can return to school in 3-5 days, but should avoid strenuous activity and sports for 2 weeks. Follow-up visits are scheduled in 1-2 weeks.

Ruptured Appendicitis
Children with ruptured appendices stay in the hospital for 5-7 days or more, and are closely monitored for complications. They receive IV antibiotics and possible drainage tubes for several days. They will experience more pain initially and have a slower return to eating and activity.
At home, your child needs to rest for 2-3 weeks before normal activities. Follow-up visits are more frequent in the following weeks.

Why Choose The Little Surgery for Paediatric Appendicitis Treatment

We provide emergency evaluation and expert paediatric appendix removal surgery, including laparoscopic and open appendectomy.

Experienced Paediatric Surgeon

Dr. Ong Lin Yin has over 20 years of experience in paediatric surgery, including extensive experience with appendicitis in children. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has performed countless paediatric appendectomy surgery procedures with excellent outcomes.

Comprehensive Care

We provide quick acute appendicitis diagnosis in children, management of abscesses and peritonitis, and emergency paediatric appendectomy surgery, including laparoscopic and open appendectomy. We coordinate with other hospital emergency services and paediatric specialists to make sure your child receives care at every step.

Family Support

We understand that emergency surgery is frightening for children and parents. We provide clear explanations of your child’s condition, detailed discussions on surgery, compassionate support throughout treatment, and long-term partnership in your child's care.
As a mother herself, Dr. Ong understands family concerns and ensures you feel informed and comfortable.

Contact The Little Surgery Today

If your child has symptoms of appendicitis, we can provide immediate medical attention.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.