The appendix is a tube like structure with a blind end protruding from the junction of small intestine and the large intestine.
It contains lymphoid tissue (cells which are responsible for fighting against infections) but it does not seem to play any important role in the human body.
Its removal is not associated with any problem.
It differs from the rest of the intestine in that its cavity is very small.
Because of the narrow cavity it can get obstructed easily leading to infection and inflammation.
Inflammation of the appendix (appendicitis) is a common cause of acute abdominal pain in children.
Manifestations: The disease starts with fever, abdominal pain and vomiting.
Though there are other diseases causing these symptoms appendicitis should always be suspected in any child who has these symptoms.
In some children vomiting may be delayed for some time and they may present only with fever and pain in the abdomen.
The pain is not well localized in the beginning and the child may point to the whole abdomen or to the area around the umbilicus.
After some time the pain usually localizes to the right lower quadrant of the abdomen.
If the doctor presses the right lower quadrant the child cries with pain.
If the child has vomited several times there may be mild dehydration.
It is important to recognize appendicitis early in children, as the risk of perforation is high.
If the appendix ruptures, the infected material spills into the cavity of the abdomen causing widespread infection and worsening of the child's condition.
Diagnosis: Appendicitis can be usually diagnosed on clinical examination.
Examination of the blood reveals increased white blood cell count suggesting an infective condition.
Abdominal ultrasound may show the thickened appendix but sometimes the appendix may not be visualized as it can be hidden behind other parts of the intestine.
But when the probe is placed on the right lower quadrant of the abdomen the child cries due to pain.
Urinary infection and stone in the urinary tract can mimic appendicitis.
Examination of the urine clinches the diagnosis.
Pancreatitis (inflammation of the pancreas), torsion of an ovarian cyst and gastroenteritis (inflammation of the stomach and the intestine) can also simulate appendicitis.
Sometimes a period of close observation may be necessary before making the final diagnosis.
Treatment: Many doctors advocate immediate surgery for appendicitis in children, as the risk of rupture is high.
The inflamed appendix is removed (appendectomy).
But there are some who prefer conservative treatment.
The latter consists of withholding oral feeding, giving intravenous fluids, intravenous antibiotics and medicines to relieve pain.
If started early in the course of the disease there can be complete resolution.
Intravenous fluids are continued till the child is free of vomiting for many hours.
Then plain water is given first, followed by liquid diet-milk or porridge.
Gradually solid foods are introduced.
Once the child is able to tolerate oral intake he can be discharged and medicines given orally.
About forty percent of children treated without operation suffer from relapse and may need surgery.