Appendicitis – Then and Now
In the early 1990s, I was an 11-year-old with appendicitis. After a visit to our pediatrician, I was referred to the Emergency Department of my home city’s children’s hospital, where I met a pediatric surgeon. He examined my abdomen, ordered an abdominal x-ray, and took me to the operating room. His diagnosis was correct – my appendix was inflamed and had ruptured – and I returned home later that week, one organ lighter.
Today, things are done a little differently. If your child arrives at Cincinnati Children’s with abdominal pain and other symptoms that suggest appendicitis, the evaluation most often will start with an ultrasound. A sonographer will apply ultrasound gel to the abdomen and use a transducer to look for the appendix, which is a small, tubular part of the intestine that usually is located in the lower right portion of the abdomen.
Image: Elongated, dilated blind ending tubular structure representing the appendix (14-yr-old patient)
Unfortunately, the appendix can be hard to find. A normal appendix measures up to about 6 mm in diameter, or roughly the size of a pencil. It is connected to the intestine at one end but mobile at the other, and it may hide behind other sections of the intestine. We are lucky to have excellent, highly experienced sonographers at our hospital, but we still find the appendix only about half of the time.
Image: Longitudinal inflamed appendix with measurements (9-yr-old patient)
If this is the case, we may rely on other signs of inflammation in the abdomen that can be seen by ultrasound, such as enlarged lymph nodes or an abnormal appearance of the normal abdominal fat, to suggest that your child has appendicitis. If the ultrasound is indeterminate and the emergency room doctors or surgeons remain concerned for appendicitis, they may order a CT scan. A CT often allows a better look at the appendix, but it is considered a secondary option for children because of its use of radiation to create an image.
Image: CT image of appendicitis, marked by yellow arrow
In the end, ultrasound and CT are complementary options for imaging a child suspected of having appendicitis. Both are effective tools that help us to identify the appendix, and, when combined with the evaluation of your emergency room doctors and surgeon, diagnose appendicitis.
Contributed by Dr. Mitchell Rees and edited by Michelle Gramke, (Adv Tech-US).