Ask the Pediatric Surgeon: Right-Side Abdominal Pain
Question: My 10 year old daughter has had many episodes of right lower belly pain over the last several months and the doctors can’t figure it out. Can this be her appendix? – Kim L.
Thanks for your question. It is hard to watch our kids have chronic or recurrent symptoms, particularly when all the “tests” are normal, yet they are sick enough to miss school and other important activities. The classic story for appendicitis is a short illness: a day or two of abdominal pain, first starting around the belly button and then moving to the right lower abdomen. Often kids have nausea, vomiting and low grade fevers. We worry about ruptured appendicitis after several days of progressive symptoms and high fevers above 101.5. This is obviously not the story for your daughter. Our first test of choice when we are worried about the appendix is an ultrasound.
Here at the Elliot hospital, I work with amazing ultrasound technicians (the only pediatric-certified in the state!) and they are fantastic with kids. Although it is challenging, they routinely find the appendix, and this is a very accurate test to diagnose appendicitis. I try to avoid CAT scans in kids because of the radiation exposure, but rarely this is necessary when we need to rule out other problems that may be causing pain. That said, even when we know it is not acute appendicitis, I do see many kids with atypical abdominal complaints that could still be coming from the appendix. We sometimes call this “atypical appendicitis” or “colicky pain of the appendix”, but it is not well-recognized in the medical world. For example, I may see a child in my office with many weeks or months (or even years!) of abdominal pain. Many of them come with all normal tests and have been seen by emergency departments, pediatricians and gastroenterology specialists.
I work closely with our pediatric gastroenterologists here at the Elliot and if we suspect the appendix and the family is willing, I think a laparoscopic appendectomy is a reasonable option. This is usually a quick 30 minute outpatient procedure that kids tolerate quite well. I have to admit, it is a great feeling when I see a child smile at me in the recovery room and announce that their symptoms are gone. Parents know there can never be a guarantee, but they appreciate being heard and helped through these difficult decisions for their kids. This is the Art of Medicine that keeps me doing what I do.
- Dr. Soukup
Elizabeth S. Soukup, M.D., M.M.Sc. – Pediatric Surgeon
Dr. Soukup is a Pediatric Surgeon at the Elliot Hospital and has an interest in educating families about pediatric health and wellness. Her mission is to provide expert specialty care for children of all ages in New Hampshire – newborns through teenagers – striving to keep them close to their families and communities. If you would like more information, call 603-663-8393 for an appointment, or visit our website at http://elliothospital.org/website/pediatric-surgery.php. Check out previous articles at #askthepediatricsurgeon.
Dr. Soukup earned her Bachelor of Science from the Massachusetts Institute of Technology and her Doctor of Medicine from the University of Chicago Pritzker School of Medicine, where she received the Outstanding Achievement Award in Medicine, graduating first in her class. She completed her General Surgery training at the Massachusetts General Hospital and her fellowship in Pediatric Surgery at Children’s Hospital Boston. During her time in Boston, she also completed a Masters of Medical Sciences degree in clinical investigation from Harvard Medical School. She is board-certified in both Pediatric Surgery and General Surgery. She has specialized training and experience in minimally invasive surgical treatment for babies, children and teenagers. Her practice includes all areas of general pediatric surgery, including common pediatric surgical problems as well as neonatal surgery, congenital anomalies, minimally invasive surgery, and complex thoracic surgical problems.