It is a small piece of intestine which, if it measures only a few centimeters, can do a lot of damage. The appendix is ​​located in the lower right part of the abdomen. When it becomes blocked most often because it is invaded by residues of fecal matter, it leads to bacterial overgrowth. It suddenly ignites: it is the attack of appendicitis.

“It is a classic cause of abdominal pain in children,” explains Professor Jean Breaud, pediatric visceral surgeon.

All parents dread her. But how do you distinguish an ordinary stomach ache from appendicitis?

What are the first symptoms?

The first symptom is pain, which is rather intense and localized. “It starts from the navel, and radiates to the lower right of the belly”, describes Professor Breaud. “Above all, it is constant, leaving no respite for the child. And it is only increasing. There may also be a moderate fever, around 38º. This is proof that the immune system is defending itself against aggression, bacterial infection. The child may also have nausea and vomiting, loss of appetite.

Warning: it may happen that an attack of appendicitis is not accompanied by any pain, or that it is not localized in the lower right of the belly. The reason ? The appendix is ​​normally located at the bottom right… but not always. It can be, for example, under the liver, or in the middle of the abdomen.

“The frequency of appendicitis is particularly high between the ages of 7 and 13, although the disease can affect any age. “In toddlers, for whom the attack of appendicitis is rare, the symptoms are not the same as for their elders. “In children under 3 years of age, insomnia, restlessness, diarrhea, loss of appetite and high fever are sometimes in the foreground”, details the Health Insurance on its site ameli.fr.

If the pain does not go away quickly, you should go to a general practitioner or pediatrician immediately. Better to consult for nothing than to wait and end up in a dramatic situation.

The diagnosis is not easy to make. This explains why before the progress of medical imaging, the scalpel was taken out much more easily… only to often notice that the removed appendix was healthy. 

From 162.700 appendectomies in 1997, we rose to 83.400 in 2012. And in 2015, the Health Insurance recorded 72.000 hospital stays for appendicitis. “The diagnosis is first and foremost based on questioning.

The chronology of the pain is established. A blood test can then be taken to look for signs of inflammation, such as an increase in the number of white blood cells in the blood. If in doubt, an ultrasound is done to confirm the diagnosis. The scanner is more precise and more reliable than ultrasound, but exposes to X-rays, which explains why it is used very little in children. “Advances in medical imaging have made it possible to sharply reduce the number of appendectomies”, rejoices Professor Breaud.

When the diagnosis of appendicitis is made, no time to waste. The child goes to the OR the same day, or the next day at the latest. He must indeed be on an empty stomach. “The operation involves removing the appendix and cleaning the abdominal cavity. It is most often performed under laparoscopy ”. The surgeon makes three small incisions at the level of the navel and at the bottom of the abdomen to pass the camera and the instruments allowing to cut the appendix and to extract it.

How is the operation carried out?

The operation is performed under general anesthesia. It lasts between 20 minutes and 1h30. The postoperative pain is calmed by paracetamol, possibly anti-inflammatory drugs. The child will generally be recovered in 24 to 48 hours. The scars left by the operation will be almost invisible. And all those who have been operated will confirm it: we live very well without this organ, not at all essential.

Treat appendicitis only with antibiotics, to avoid going through surgery? Some doctors recommend it for uncomplicated forms when the inflammatory lesions remain limited to the wall of the appendix – acute appendicitis. But for the moment, the Haute Autorité de santé considers that “its effectiveness has not yet been demonstrated in a significant way to allow a substitution today for appendectomy. “

If appendicitis is not treated in time, it can degenerate into peritonitis. This life-threatening emergency means that the appendix continued to get infected, until it eventually perforated. “Pus then spreads into the abdominal cavity, which is very serious. The pain is intense, the abdomen hard and tender to the touch.

The 15 must be contacted immediately. The small patient will then usually receive a large dose of antibiotics to counter the infection, and will be operated on to remove the appendix. And he will have to put his bags in the hospital for at least one week.