The appendix is a small tube located at the end of the caecum, the first part of the large intestine. It is called vermiform appendix as it resembles a worm. It is usually eight to ten cm. long. Its structure is made of tough fibrous outer covering which protects the entire ailmentary canal. There is a layer of muscular tissue under the outer covering and further a layer of lymphoid tissue.

Symptoms

Diagnosis may be specifically difficult in young children, because it may not be possible to obtain accurate history. The sequence of symptoms is less characteristic than in adults. The child always loses his appetite and he may vomit. He becomes irritable and cries with pain. The pain usually begins at the centre of the abdomen, which gradually shifts to the lower right side. The pain may be preceded by general discomfort in the abdomen, like indigestion,diarrhoea or constipation. The muscles of the right side of the abdomen become tense and rigid. The pain increases on the right side on pressing of the left side of the abdomen.

Coughing and sneezing makes the pain worse. Perforation is much more common in infancy, duirng which period mortality rates are highest.

If the inflammation continues to increase, the appendix may rupture and discharge its pus into the abdominal cavity. This may result in a serious state known as peritonitis. The temperature rises and the patient becomes pale and clammy. This condition may call for urgent operation. In the chronic state of appendicitis, the patient may suffer from recurrent pain in the right lower abdomen with constipation, loss of appetite and mild nausea.

Causes

The passage of the appendix can be blocked by hard piece of foecal material or worms causing inflammation of appendix. The other view is that appendicitis is caused by a toxic bowel condition. An excessive amount of poisonous waste material is accumulated in the caecum. As a result, the appendix is irritated and over- worked and becomes inflammed. It is an attempt on the part of nature to localise and ‘burn up’ the toxins. This condition is initiated by wrong feeding habits and enervation of the system. The inflammation of the bowel limning, due to the habitual use of aperient drugs, is a potent perdisposing factor in the development of appendicitis. Further inflammation and infection comes from certain germs which are usually present in the intestinal tract.

Treatment

The child should be put to bed immediately at the first symptoms of severe pain, vomiting and fever. Rest is of utmost importance in the treatment of this disease. NO solid food should be given for one or two days. The child should be given plenty of water to drink. He may also be given fruit juices diluted with water. Low enemas of warm water may be adminstered in early stage to cleanse the bowels, if the child can tolerate it. An ice bag should be used again for 15 minutes, followed by hot application for three minutes. The alternate use of the ice bag and hot applications may be continued until the pain has subsided.

After the acute symptoms have subsided, the child may be placed on a diet of liquid foods and fresh juicy fruits such as oranges, lemon, pineapple, apple, grapes and papaya for further two or three days. Thereafter, he may be gradually allowed to embark upon a well-balanced diet according to his age. The emphasis should be on whole grain cereals, fresh fruits and raw vegetable salad.

Certain home remedies have been found beneficial in the treatment of appendicitis. Green gram (mung) has proved effective in the acute phase of the disease. A handful of this pulse should be soaked overnight in water. This water is used as a medicine for treating this condition. It may be given in small quantities of one teaspoon to the chld two or three times daily.

Regular use of tea made from fenugreek (methi) seeds has proved helpful in preventing the appendix from becoming a dumpting ground for excess mucus and intestinal waste. This tea is prepared by putting half a tablespoon of the seeds in 250 ml. of cold water and allowing it to simmer for half an hour over a low flame. It should be allowed to cool a bearable temperature and the strained. It can be given to the child once daily.

Certain vegetable juices, especially carrot juice, in combination with the juices of beet roots and cucumbers, have been found valuable in appendicits. In this combination, 50 ml. each of beet root and cucumber juices should be mixed with 150 ml. of carrot juice. It may be given to the child-patient twice daily. The use of buttermilk is beneficial in the treatment of chronic form of appendicitis. About 250 ml. of buttermilk may be used for this purpose.

The consumption of whole wheat which includes bran and wheat germ, has been found beneficial in preventing several digestive disorders including appendicits. The bran of wheat can be sterilised by baking after thorough cleaning. This sterilised bran can be added to wheat flour in the proportion of one to six by weight. One or two chappatis made from this flour can be eaten by the child daily for preventing the disease.

The patient of appendicits should adopt all measures to eradicate constipation, if it is habitual. Much relief can be obtained by daily application of hot fomentation and heating compresses (as explained in the appendix). Once the waste matter in the caecum has moved into the colon and thence eliminated, the irritation and inflammation in the appendix will subside and surgical removal of the appendix will not be necessary.

When all the measures have failed and infection is so severe that there are chances of perforation or formation of appendicular abcess then only surgical removal of appendix is necessary.