Pediatric Appendicitis

[Lucy0657]

My 5 year old granddaughter was recently diagnosed with a ruptured appendix.  She's been in the hospital for 4 days on anitbiotics and they are talking about sending her home on anibiotics for a month or two before removing the appendix.  

I've never heard of such a thing.  Is this common practice?

[ladymadonna]

My son is 9 years old was suffering from bouts of severe diarrhea coupled with stomach cramps and hardly ate anything.  We did a stool sample and nothing came back, then no symptoms for a couple of months.  About six weeks ago the symptoms returned and his pediatrician prescribed prevacid and didn't help.  

A couple of days later, the symptoms returned and the doctor prescribed 20mg twice a day - 40 mg total.  I was surprised that the dosage was twice the adult dosage but it has been a miracle.  His appetite returned almost immediately and we are following up with the doctor at the beginning of the month.  

I read that Prilosec carries a risk of pancreatitis and liver problems in children and hasn't actually been approved for pediatric use.  Can someone clarify about the long-term effects and best course of treatment or test I should ask about?

[surgeon]

If the appendix ruptures and walls off into an abscess, it may not require emergency surgery; if the abscess is small enough, antibiotics alone may do the trick. If it's larger, then it may need draining. Under these circumstances, it may be elected to put off the actual removal of the appendix until the infection subsides; that way, you don't risk spreading the infection around within the abdomen. After it subsides, the appendix is later removed, to prevent the whole thing from happening again. It's not a highly unusual way to handle the situation, depending on the specifics. I've done it that way many times.

[Kevin Pho, MD]

Our surgical colleague has answered this question in his comments below and I agree with his answer.  I'll reprint it here since comments aren't saved:

"If the appendix ruptures and walls off into an abscess, it may not require emergency surgery; if the abscess is small enough, antibiotics alone may do the trick. If it's larger, then it may need draining. Under these circumstances, it may be elected to put off the actual removal of the appendix until the infection subsides; that way, you don't risk spreading the infection around within the abdomen. After it subsides, the appendix is later removed, to prevent the whole thing from happening again. It's not a highly unusual way to handle the situation, depending on the specifics. I've done it that way many times."

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b