What Is This Condition?
Appendicitis is a medical emergency in which the appendix is inflamed due to obstruction and may rupture and spread infection. This is the most common major surgical emergency, affecting men and women equally. Left untreated, appendicitis is fatal, but surgery is an effective cure. A sudden inflammation of the appendix. The appendix is a narrow, small, finger-shaped tube that branches off the large intestine.

What Causes This?
Appendicitis is probably the result of an obstruction in the appendix. A bit of stool, constriction, or a viral infection may cause this blockage. The obstruction causes inflammation, which may lead to infection, a clot, tissue decay, and perforation. If the appendix ruptures, the infection spills into the abdominal cavity and causes peritonitis, the most common and dangerous complication of appendicitis. 

Appendicitis is one of the most common causes of emergency abdominal surgery in children (also in adults). Approximately 4 appendectomies per 1000 children under age 18 are done anually in the United States (Note: appendicitis is not diagnosed in 100% of appendectomies). It is more common in males than females and incidence peaks in the late teens and early twenties. Appendicitis is uncommon under age two but can occur. Appendicitis generally follows obstruction of the appendix by feces (fecalith), a foreign body, or tumor.

Symptoms of appendicitis in young children are seldom classic so diagnosis is commonly delayed and perforation more likely. Older children and adolescents have a more typical presentation.

Classic presentation of appendicitis begins with crimpy or "colicky" pain around the navel (periumbilical). There is usually a marked loss or total absence of appetite (anorexia). As the inflammation in the appendix increases the pain tends to move downward and to the right (right lower quadrant, RLQ) and localizes directly above the position of the appendix at a point called "McBurney's Point". (If a line is drawn from the navel to the prominence on the right pelvic bone (right superior iliac crest) and divided into thirds, McBurney/s Point is 2/3 away from the navel).

The child may be quite tender when the abdomen is pressed at McBurney's Point. When the abdomen is depressed on the left side, held momentarily, and then rapidly released the child may experience a momentary increase in pain (rebound). This finding suggests inflammation has spread to the peritoneum.

If the appendix ruptures the pain may disappear for a short period and the child feels suddenly better. However, within a short period peritonitis sets in, the pain returns, and the child becomes progressively more ill. At this time the abdomen may become rigid and extremely tender.

How Does This Present Itself?
Symptoms usually occur in the following sequence: 

• pain in or around the upper right abdomen highly inaccurate the pain typically starts in the central abdomen around the umbilicus then shifts to the lower right abdomen but may start and remain in right lower abdomen. The pain uncommonly occur in right upper abdomen.

• loss of appetite, nausea, and vomiting 

• pain concentrated in the lower right abdomen, with a board-like abdominal rigidity (rigidity occurs first in the lower ouadrent and whole abdomen my become board like when appendix has ruptured. 

• increasingly severe abdominal spasms and soreness to the touch

• lower left side painful to touch, suggesting an inflamed lining of the abdomen 

• constipation (possibly diarrhea), slight fever, and rapid heartbeat 

• abdominal pain that ends suddenly (usually means that the appendix has perforated or burst)
  
  Additional symptoms that may be associated with this disease:

• Urine, bloody (microscopic hematuria)

• Anal lump no "Anal" lump has ever been associated with appendicitis in the medical history ! A lump can occur in the right lower abdomen.
  
  

How Is It Managed Conventionally?
Appendectomy, surgery to remove the appendix, is the only effective treatment. Laparoscopic appendectomies may be performed through very small incisions. If the infection has spread and peritonitis develops, antibiotics are used to fight infection and tubes to drain the abdominal cavity