An ultrasound of Tai at Tam Anh General Hospital in Ho Chi Minh City revealed his appendix measured 10 mm in diameter (normal is under 6 mm), with fatty infiltration indicating inflammation and fluid in the abdomen. Blood tests showed a white blood cell count of 12,000/mm3 (normal is under 10,000/mm3), with 86% neutrophils, indicating a bacterial infection.

Doctor Ton Thi Anh Tu, from the Pediatric Surgery Department, stated the patient had acute appendicitis, with a ruptured appendix leading to peritonitis. Surgery was urgently needed to prevent bacteria from spreading from the abdomen into the bloodstream, potentially causing sepsis, septic shock, and multiple organ failure affecting the kidneys, liver, and respiratory system, which could be fatal.

The doctor made small incisions in the abdominal wall near the navel and pelvic region, insufflated CO2, and inserted a camera to assess the damage and remove the appendix. Because the inflamed and ruptured appendix had spread bacteria throughout the abdomen, the abdominal cavity was irrigated, and a drain was placed. After over 60 minutes, the surgery was successful, and Tai was discharged after three days.

Doctor Tu operating on the patient. Photo: Tam Anh General Hospital

Doctor Tu operating on the patient. Photo: Tam Anh General Hospital

Peritonitis in children is widespread inflammation of the abdominal cavity. It is a complication of appendicitis that progresses rapidly, with initial symptoms easily mistaken for common digestive disorders. In Tai's case, the three-day delay allowed the appendix to become severely inflamed, leading to necrosis, swelling, and eventual rupture.

Besides peritonitis, a ruptured appendix can cause appendiceal abscess, a localized infection around the appendix enclosed by nearby organs like the small intestine, large intestine, and omentum, forming a pus-filled pocket. This complicates surgery due to adhesions and increased risk of organ damage. Post-operative bowel obstruction is also more likely. Treatment typically involves antibiotics to resolve the inflammation before considering an appendectomy weeks or months later. Another complication is an appendiceal mass, where surrounding tissues encapsulate the inflamed appendix, forming a firm, swollen mass. This is also treated conservatively with antibiotics to reduce inflammation before considering an appendectomy after several weeks or months.

Symptoms of appendiceal peritonitis in children include dull or cramping abdominal pain, starting in the upper abdomen and around the navel before moving to the lower right quadrant. The pain may lessen after the appendix ruptures but then spreads throughout the abdomen. Children may experience nausea, loss of appetite, bloating, diarrhea, dry lips, and a coated tongue.

Cases involving fever, fatigue, severe abdominal pain, and poor appetite, like Tai's, indicate a worsening infection requiring immediate hospitalization. Peritonitis in children is usually treated with an appendectomy, abdominal lavage, drainage of accumulated fluid, intravenous fluids and antibiotics, and nutritional support.

To prevent this condition, parents should ensure prompt diagnosis and treatment of appendicitis before complications develop. If a child shows suspicious symptoms, parents should immediately seek medical attention and avoid self-medicating. Maintaining a balanced and healthy diet, practicing good hygiene, and undergoing regular check-ups to screen for digestive issues are also recommended.

Dinh Lam

*The patient's name has been changed.