BABY AND CHILDHOOD DIGESTIVE SYSTEM DISORDERS: APPENDICITIS
‘Ben isn’t very happy’, Judy said, as she marched Master Ben into my surgery. They both took a seat. Ben, normally a happy little fellow, bright and beaming, now looked dour and miserable.
‘What gives,’ I asked.
He says he has a stomach ache. Ben never complains of stomach aches, so when he said this and didn’t make any effort to get up this morning, I thought it was time to do something.’
‘Good idea,’ I replied. ‘Fellows of Ben’s age usually do not complain for nothing.’
‘I agree,’ answered Judy. ‘The pain was mainly around his belly button to start with. That was this morning. But new he says it has moved down to the lower right hand side of his tummy region. Excuse my non-technical terms, but that’s how it is.’
‘Might as well use words we all understand,’ I said with a smile. People often worry about not being able to use medical terminology when describing symptoms, but I prefer the simple easy-to-understand terms, and most of my patients prefer this also.
‘Ben didn’t want any breakfast today—quite unusual for him. In fact, he even vomited later in the morning. Not much. But he hasn’t been to the loo either for a bowel action, and he says it’s a bit uncomfortable when he passes his water.’
Ben looked a bit flushed, unhappy and obviously not his usually cheery self.
‘Let’s have a check,’ I suggested, lifting Master Ben on to the examination cot.
I gently prodded his bare tummy. At the same time I watched his face which was screwed up in an unhappy wince. This increased as I pressed a little firmer into his R.I.F. (that is short for right iliac fossa). This is the part located in the lower right-hand side of the abdomen. Draw an imaginery line from the naval to the front part of the hip bone. Now divide this into equal thirds. The critical point is where the middle and lower thirds meet. When I put a bit of pressure over this spot, Ben gave a decided yowl of discomfort.
‘Ouch! That hurts,’ he moaned, and a few tears rolled down his cheeks.
‘Okay, Ben,’ I said. That’s nearly all.’
I was pretty convinced Ben had an acute appendicitis, for the appendix lies directly beneath this critical point. In addition, the muscles over the abdomen were fairly tense, another indication that inflammation was active in the depths of his abdominal region. I guessed the appendix was fairly close to his bladder, probably causing some irritation there, too—hence the urinary symptoms his mum had mentioned.
‘Just one more check,’ I said to Master Ben. I then did a quick examination of his rectum, via the back passage. I was very gentle, but inside my finger soon hit a spot that made Ben yelp once again.
This clinched it. I was now quite certain I had touched the vital spot, an inflamed appendix, without doubt.
Ben lay there, with his legs drawn up. Obviously this position gave him some relief from the discomfort. Although a bit pale, he didn’t seem to be running any elevated temperature at this stage— not uncommon in the early hours of this disease.
‘I think there is little doubt about a diagnosis,’ I said to Judy. ‘Ben has appendicitis.’
‘What now?’ was the inevitable reply. ‘Will his appendix need to come out?’
‘That would be the best idea,’ I replied. ‘And the sooner the better. I’ll get on the phone to the hospital right away and make the necessary arrangements. Do you want to phone your husband and tell him what we think? Or would you like me to speak to him?’
‘I think I’ll let you talk to him after you’ve fixed it with the hospital,’ Judy said. ‘He’ll ask all sorts of questions, and you’ll be able to answer them more fully.’
It didn’t take long to contact the hospital and my surgeon colleague who would carry out the surgery. Then I gave Ben’s father a ring, told him what I felt about Ben, and got his approval and blessing.
‘Go ahead, and make whatever arrangements you think are best,’ he said. ‘I know you will get a good surgeon.’
I hung up and turned to have a further chat with Judy—and Ben, if he was sufficiently interested, which it happened he was.
Appendicitis is a fairly common disease, but it doesn’t bear playing around with. In fact, statistics show that about 60 Australians perish annually because the diagnosis is overlooked (generally because parents fail to take their children along early enough) and surgery is delayed. It should never occur in these modern days, but it continues to do so, I am sorry to say.
It is probably the most common abdominal disorder that requires surgery in childhood. Most cases are in the 4-12 year age bracket, but nobody is immune. There has even been reported a case in an infant only a few weeks old. Diagnosis at that age is terribly difficult.
The cause
And what is the cause of appendicitis? The doctors are not quite sure. In some cases, the opening of the appendix becomes jammed up with debris from the bowel—little hard lumps called faecoliths. In other cases, especially in children, it can be caused by worms blocking the opening, germs and debris packing up inside and an infection born and rapidly developing into an acute situation.
It is surprising how rapidly the infection can develop. In some acute cases the appendix has increased in size enormously. The walls and contents become filled with pus, dead germs and debris. Unless surgery is carried out as a matter of urgency, then the entire organ may rupture. A mass of debris will spill into the abdominal cavity, and this situation becomes serious, involving peritonitis— infection of the lining of the abdominal cavity.
In the days before the advent of the antibiotics, this was often fatal, though today peritonitis can be prevented. Acute cases are now operated on quickly, for all hospitals are geared with the facilities to handle this common emergency.
Many other cases of appendicitis develop slowly. Starvation, regular fluids and nursing may help. But doctors still do not like taking risks if there is any doubt.
Occasionally sore throats can sometimes give a condition that mimics appendicitis. It is called mesenteric adenitis. The symptoms can be almost identical. Small glands scattered about in the abdominal cavity, called lymph glands, may become infected. They are often preceded by a simple sore throat from which infection spreads. Often there may also have been a respiratory tract infection, which has spread to the abdominal region. In fact, many cases have been misdiagnosed as appendicitis. However, it is better to err on overdiagnosis, most doctors believe, than to miss a serious case of acute appendicitis which may otherwise cause a seriously ill patient, or even a fatality.
By this time Ben had climbed down from the cot, and with mum’s help had dressed.
‘Nothing to eat or drink,’ I cautioned. ‘Straight up to the hospital, and before nightfall the appendix will have been removed. I’m sure there will be an excellent recovery. Within a few days you’ll all be home, together again.’
‘I’m much happier now that we know what the problem is,’ Judy said. ‘Thanks for your help.’
*50\87\2*
Related Posts:
Leave a Reply
You must be logged in to post a comment.