Appendicitis Treatment Options

How do I know if my child has appendicitis? Few parents get through the journey of raising children without wondering this at some point.

In the late 90s, one of my early mentors, the late Dr. David Scott, showed me a whole stack of cases of diagnosed appendicitis that he had helped children and adults recover from through rest and water fasting. Given the wealth of his experience utilizing water fasting to help people overcome countless health challenges that allopathic medical care typically addresses via surgery and/or medication, I had good reason to wonder if excision was the best first line treatment for appendicitis.

Today, some within conventional medicine also question the decision to use excision as a first line treatment for appendicitis. Studies like "Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice." are prompting some physicians to try a combination of intravenous and oral antibiotic therapy in mild to moderately severe cases of appendicitis where there is no clinical evidence of perforation.

Rupture is the major danger of unresolved appendicitis. If inflammation is severe enough, the appendix can open up and spill bacteria into the abdominal cavity, which can lead to a serious infection called peritonitis or formation of an abscess (an enclosed pocket of pus).

Parents who have stood witness to their young children suffering with severe unexplained abdominal pain know the agony of wondering about appendicitis and whether a trip to the emergency room is in order. In my experience, even physicians can feel conflicted about what to do when their own children have what appears to be appendictis - it's never an easy task to objectively assess your own child's suffering.

Classic symptoms of appendicitis include:

1. Loss of appetite.

2. Dull, ill-defined pain around the navel region or just above it. This pain becomes sharper and more defined as it migrates to the lower right abdominal region.

3. Nausea and/or vomiting, typically after abdominal pain begins.

4. Mild to moderate fever.

5. Difficulty passing gas.

One simple assessment that parents can do is to check for pain upon palpation of the right lower abdominal region in the fleshly region that borders the upper portion of the right pelvis. This can be done by gently pressing the pads of the fingers of one hand, supported by the pads of the fingers of the other hand, gently into the right lower abdominal region and observing for discomfort. In some cases, palpating this same region in the left lower abdominal region can increase pain felt in the right lower abdomen - called Rovsing's sign - which can be indicative of appendicitis.

If you feel that your child has appendicitis, if at all possible, you should take your child to the nearest children's hospital; the idea is that if surgery is needed, it is best to have access to a surgeon who has experience addressing appendicitis in children. A good friend of mine who is a radiologist by trade is firm on taking his own young children to the best children's hospital in the area whenever he deems it necessary to seek medical care for them. And my head echoes with the mantra of the many surgeons I have spoken with over the years: if you absolutely need surgery, make sure you go to someone who regularly performs the procedure you need.

At a hospital, beyond standard history taking, a general assessment including an abdominal exam, and blood and urine work, ultrasound is often the diagnostic tool used to identify appendicitis. Where there is severe appendicitis that requires surgery, it is rare to have a false positive finding using ultrasound.

If the classic symptoms and signs noted above are mostly absent and you feel that watchful waiting at home makes sense, I would suggest giving your child a quality probiotic regularly - once every two to three hours isn't too much, provided that your child can comfortably ingest the probiotic. For children, I have long used Dr. Ohhira's professional grade probiotic, as it's simple to cut off the ends of their capsules, squeeze out their probiotic paste, and feed the paste with a spoon. Quality rest is also essential to facilitating recovery, of course.

The main differential diagnosis for appendicitis is mesenteric lymphadenitis, sometimes called mesenteric adenitis, which can accompany a common cold, the flu, or even occur on its own, mainly occurring in children and teens. Mesenteric lymphadenitis produces some of the classic symptoms and signs that appendicitis does, but is typically self-limiting, clearing up on its own without a need for treatment.

When would I take my own children to a hospital for possible treatment? If there was significant pain, no appetite, a fever, and pain with palpation of the right or left lower abdomen, I would consider it responsible to visit the nearest children's hospital. If appendicitis was diagnosed at the hospital but it was deemed likely that there was no rupture, I would ask if they would please try oral antibiotic therapy as a first line treatment over 24 hours before considering surgery.

I hope these thoughts are helpful in some way. The bright side of this health issue is that we can likely reduce risk of experiencing appendicitis by following a diet that promotes healthy and regular bowel movements - this diet would include a wide variety of nutrient-rich plant foods and healthy fats.

If you have any questions on this or any other health topic, please feel free to write to me directly at benkim@drbenkim.com.