Dr Phil Kieran: Should the consultant have removed my granddaughter's appendix?

Was a strong course of antibiotics the correct treatment plan?

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My 10-year-old granddaughter was recently diagnosed with appendicitis. The consultant recommended a course of strong antibiotics as the main treatment plan. Would it be better to remove the appendix to rule out the risk of future infection?

Appendicitis is terrifying for a parent. I remember when my son was admitted for emergency surgery to have his appendix out a few years ago.

If you had asked me this question five or six years ago, I would have said, categorically, that it is better to remove the appendix and be done with it. This is still the case, mostly, but there is a move recently to consider treating it with strong (broad-spectrum) antibiotics and to monitor the child intensively.

The appendix is a small, worm-shaped tube attached to the large intestine. It was thought to be pointless, an organ only interesting because it could kill you if it ruptured.

In some plant-eating animals, the appendix is much larger and is involved in breaking down tough plant matter, but this is not its role in humans.

We now think that it may have the purpose of storing normal gut bacteria to repopulate the bowel after food poisoning or a vomiting bug. Either way, it’s a good idea to keep all your parts where they are, if possible.

Appendicitis most commonly happens in children aged between four and 14. It is more common in boys than girls and tends to be more severe at diagnosis in children aged six or under.

Symptoms typically start with a sore tummy, which progresses to increasingly severe pain. As the pain gets worse, it can move to the lower right-hand corner of the abdomen and the child will likely want to lie still, as any movement can worsen the pain. There may also be vomiting or diarrhoea, and there is usually a loss of appetite.

If these symptoms are present, you need to see a doctor. They will examine the child and likely send you to hospital through the emergency department. There will be another examination, some blood tests, and probably a scan.

If the blood tests are reassuring, your child isn’t particularly unwell, the scans are not too worrying, and your child can tell staff how they are feeling, the surgical team may suggest antibiotics and to monitor the situation to see if it can be treated without surgery. These criteria will only apply to a small percentage of children with appendicitis, but if your child is one, I would say it is definitely worth waiting.

Surgery comes with the risk of complications, it has a longer recovery time, and if you can save the organ, as I said above, it’s better to leave things where they are. However, if there is any doubt, the surgeons will advise removal.

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