By Dr. Tara Shirazian
Last month, I had an unexpected issue arise with my 9 year old son. One night he developed some mild nausea and vomiting, which he frequently does when he’s sick, and the next morning felt better so he went to school. I got a phone call from our school nurse Danielle, stating that he wasn’t looking like himself and had a lot of belly pain, “I think he should see a doctor,” were her words. OK, I’m coming home to see him. When I examined him, he had acute/significant abdominal pain but mostly in the right lower area of his abdomen. This is a classic sign of appendicitis. He was also “guarding” his belly and didn’t want me to examine him. Another really important sign was that he couldn’t walk without holding the right lower area of his belly, and the pain was much worse when he jumped up and down.
Kids get belly pain and nausea/vomiting ALL THE TIME. If your kids are anything like mine, they are frequently complaining of belly pain, so it’s difficult to know when it’s significant enough to warrant a visit to the ER or to the pediatrician. Most of the time I want to get it right, because a trip to the pediatrician usually equals little more than a recommendation of rest and motrin.
I knew it was appendicitis because of how bad the pain was to the touch and where it was localized. I was shocked he had it so early at age 9! But common age range is 6-18. No one in my entire family had ever had appendicitis up to this point. So, at 11am we headed to the ER. My son was really worried about surgery and I knew that’s what we were getting, but I told him one step at a time, we needed some imaging first to look at the appendix. I also called my pediatrician, “Can you let the ER know we are coming in and I’m worried we have appendicitis.” It’s helpful to give the ER a “heads up” because they are frequently busy and appendicitis is a surgical emergency.
So, we arrived in the ER and I learned that kids largely don’t get CT scans (avoid any radiation exposure), they get ultrasounds. We got an abdominal ultrasound, and we had the head radiologist for kids reading the scan so she was able to see right away that the appendix was enlarged and there was some free fluid around it. If they can’t see the appendix ask for a read by someone more senior or experienced! Next, we saw the pediatric surgeon. Ironically, I knew him as I had worked as an OBGYN in the same hospital many years ago. He assured us that we would get surgery as soon as possible.
That was about 12:30 on a Thursday. We had the entire workup and diagnosis in about 1.5 hours, and then they transferred us to the ER to wait. We waited and waited. I complained after a few hours that my son’s pain was getting worse and I wanted to see the surgical team immediately. It’s important to know that you want to avoid the appendix rupturing! A rupture can mean a hospital stay for a few days and antibiotics and it complicates the surgery and the recovery for your kid. After complaining to a few more people and raising hell a bit in the ER, we finally got called for surgery at 5pm. There was only one pediatric surgeon in this well reputed academic center hospital. The surgery went well. It was one hour and was done laparoscopically, the appendix thankfully had not ruptured, but was extremely close.
So, what did I learn from this experience?
- Look out for the signs I bolded above. Appendicitis rarely happens before age 6.
- Get to the ER early and alert your pediatrician so they can help get you in
- Advocate for your child! If you’re sitting and waiting a while remind them that he/she is in pain and needs surgery. You want to avoid the appendix rupturing.
- Remember to stay calm, you don’t want your kid anxious but you want to expedite.
- Appendix surgery is a very common surgery in kids, any major hospital should have experience in performing them and the outcomes are largely very good.