To Your Health

Q. My 9-year-old son just spent eight days in the hospital after his appendix ruptured and peritonitis developed. It was a very scary experience, especially since I thought appendicitis was no longer a life-threatening problem. I have two other children, ages 2 and 5, and I would like to know how to reduce their risk of appendicitis.

A. The appendix is a finger-sized projection of the gut, near the connection of the large intestine to the small intestine, usually on the lower right side of the abdomen. Before antibiotics, a ruptured appendix was often a death sentence, so it became customary to remove the appendix if abdominal surgery for any other reason was necessary. There were no obvious or immediate health problems resulting from removing the appendix, and it has remained a routine procedure, even after antibiotics greatly reduced the health risk from appendicitis. Over the years, the use of antibiotics for trivial problems has led to development of antibiotic resistant bacteria, and we are again in the situation where appendicitis can be life-threatening.

No laboratory test is specific for appendicitis, so early recognition of symptoms is very important, especially in children. The classic symptoms of appendicitis are pain centered on the belly button that later moves to an area roughly corresponding to the location of the appendix in the lower right portion of the abdomen. This is usually followed by mild fever, loss of appetite even for favorite foods, and vomiting. It is significant that with appendicitis, as opposed to gastroenteritis, abdominal pain begins before nausea and vomiting, rather than after. Also, if your child seems to be moving slowly and carefully, ask him or her to jump up and down. This will shake up the peritoneal cavity, and if it is irritated with an inflamed appendix this will dramatically increase the pain.

It is still unclear if there are long-term consequences to an unnecessary appendectomy. Everyone agrees that an appendectomy can save your life if you need it, but a recent article in Gastroenterology (January 2003) indicates that appendectomy for adult women (but not men or children under age 10 years) is associated with an increased risk of Crohn's disease. Appendicitis is not easy to recognize even for experts, but if in doubt, a CT scan to visualize the appendix helps to confirm appendicitis when the diagnosis isn't clear.

Low intake of fiber and high intake of sugar, hallmarks of the diets of American children, are increasingly implicated in disorders of the gut, including chronic constipation that is often thought to be associated with appendicitis. One study found that the more fresh and frozen green vegetables people ate, particularly cabbage, cauliflower, peas, beans, and Brussels sprouts, the less likely they were to develop appendicitis. Unfortunately these vegetables are not popular with children, but other fiber sources such as whole fruit and whole grain cereals and bread can substitute. Another study indicates that breast-feeding reduces the later incidence and severity of acute appendicitis in children.

About 7% of the U.S. population will have appendicitis at some time in their lives, most often between the ages of 10 to 30 years. You cannot immunize against appendicitis, but you may be able to prevent it.