Though appendicitis risk is low, it's best to know what to look for


Q: This may sound crazy, but I dread our family vacation because I'm afraid my 10-year-old will get appendicitis. I did when I was about that age, and I got very sick. How would I know if my son had appendicitis? We are going to be camping in the mountains.

A: As far as we know, appendicitis doesn't run in families and there is no reason why a 10-year-old should be a special risk, so we don't think you need to be more concerned than anyone else. The chance that your son will come down with appendicitis during one particular week of his life is very small. Nevertheless, appendicitis can lead to severe illness and even death if not recognized in time and can be particularly tricky to diagnose in young children, so it is important to know what to look for.

The first sign of appendicitis is usually abdominal pain centered around the umbilicus (belly button). The pain gets worse over several hours and moves to the right lower part of the abdomen. That is the location of the appendix in most people. In a few individuals the intestines are rotated in such a way that the appendix ends up somewhere else, so if the pain is severe but not in the right place, appendicitis must still be considered.

Other symptoms may appear after the onset of abdominal pain. There is almost always loss of appetite and may be vomiting and low-grade fever. Movement makes the pain worse, so a person with appendicitis is usually reluctant to roll over and if forced to walk, may walk bent over. If your child, or anyone who has not had the appendix removed, develops these symptoms on vacation, he or she should be taken to the nearest emergency department. Do not be relaxed if the pain disappears, if the person still seems ill. The pain may have gone away because the appendix has ruptured (burst open). When this happens, the bacteria that live in the intestine escape into the abdomen, and may cause life-threatening infection. Thus, appendicitis requires timely surgery.

However, we hasten to repeat that appendicitis is unusual enough that it is quite unlikely to interrupt your vacation. Have a good time!

Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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