Daughter had ruptured appendix /peritonitus

[stirrupleathers]

My 10 year old daughter was admitted to hospital recently with a ruptured appendix. Once they got her into theatre the infection was so bad that they had to open her right up to wash out the infection. She had peritonitus so spent 4 days in intensive care, ventilated and then kept sedated. A few days later her stitches popped open as the surgeon obviously hadn't been able to remove all the infection. She then spent a further three weeks in hospital recovering as she was very very poorly. She had a negative therapy VAC system attached to her tummy in order to drain out the infection, she was sent home with it and the Diana nurses looked after her in our home.

The VAC system was removed a few days ago as her tummy is healing nicely, although she has a huge wound, dressings are being applied three times a week by the nurses. I think she's ready to go into school, mornings only for a while. What do you think? Am I being too hasty? She's missed so much school, but on the other hand I nearly lost her. :( What's everyone's thoughts?

[helensburgh]

I always think with kids the sooner you can regain normality the better.
Glad she is on the mend sounds like an awful time.

[CocktailQueen]

What does her doctor think? What have they advised?

[fusspot66]

I would keep.her away from crowded places for a while. Even a cold would be very unpleasant right now and her immune system will be down. Can you get her out for a walk every day? Build her up?

[Chillywhippet]

It's hard to get balence between encouraging and overprotecting. My Dd had her appendix haemorrhage a few years ago. Although she wasn't as ill as your DD it took her ages to shake off the fatigue.

I think about when I have been unwell, say with proper ful. After a week or so I feel fine at home but on returning to work realise I'm not right still. Some time in school might be good but every morning might be too tiring.

Have you spoken with the district nurse/GP about the timeframe for her recovery? When was her surgery? If she still has a dressing on her wound a morning and playtime might be too much?

[DramaAlpaca]

Something similar happened to a friend's DD who's a similar age to yours a few weeks ago. She wasn't as unwell as your DD has been, but she had complications after appendix surgery, was quite weak afterwards & she's still recovering.

I wouldn't rush to send her back, tbh.

All the best for your DD's recovery, she (and you) have been through a tough time by the sounds of it

[llhj]

Wow that sounds horrendous. My sympathies. She should only be going in to school when 95+% recovered. If she's nearly bank to normal then build her day up over a 4 week period. Schools are v infectious places and her immune system has been horrendously compromised. I'd be in no hurry at all. Could she complete some work at home?

[stirrupleathers]

Oh wow thanks for the messages. Her consultant said she could go back to school as normal. Really ? At that point she still had the drain attached to her tummy!! I ignored that advice! The Diana nurses advised us to do 25% more than she was doing with the drain attached. She advised a phased return to school, I'm worrying how school will keep her away from flying elbows etc. I wouldn't let her out at playtime and would collect her at 12 so it would be three hours! Argh I feel that I should keep her home this week...hmmmm...

[llhj]

Follow your instincts. A week is nowt in the scheme of things. Is she put and about at all?

[llhj]

Out not put!

[FadedRed]

Certainly discuss this with the Health Care staff and the school, but given that history, I wouldn't be in a rush to send her back to school in January, when the risk of Norovirus and cold/flu etc is very high,especially after the Christmas holiday when lots of children will have been mixing with people outside their normal 'local' environment. The last thing she needs now is to to get a respiratory or tummy bug.
Can the school send you some catch-up study plan to help her to get up to speed with some of the stuff she is missing?
The school might also be reluctant to have her there while she still has an unhealed wound.
You've all been through such a difficult and worrying time, you need to take things gently IMO.

[stirrupleathers]

She's been out in a wheelchair, walked to the local.shop yesterday just five mins away. Yes school have already sent work home (before Christmas) . I might wait and send her back next week!!!

[HanSolo]

I hope you all managed to have some Christmas fun- it sounds like a very scary time for you all. I hope she recovers quickly

[llhj]

She needs to be doing far more than that before I'd be comfortable sending her in for even half days. She should be able to walk for about 15 minutes and have had trips to libraries, coffee shops, cinema etc first.

[TheoriginalLEM]

keep her home. and bugger the work sent home unless she wants to do it.

[dratsea]

She will come to no harm going to school. Her immune system will be fully powered and she is not infectious even with a Vac dressing. She will get amazing street cred and even going in say 9.30 to 12.30 twice a week will keep up social contacts. Rare to need a vac in a child but from my experience in adults they save a load of problems in the long term. Poor school will go apeshit but that is their problem.

Not many 10yr olds would get through what she has been through, I think both she and you must be tough cookies, and as age appropriate.

[stirrupleathers]

Dratsea I'm guessing you know about a VAC system? The Drs said they had never used one on a child before (Leicestershire) Id never heard of it before, its amazing. Her wound has shrunk so much. When it popped open you could almost see her digestive system behind, god knows how I looked at every day. I had to be with her holding her hand so I couldn't lose it!!!

I will send her in twice a week for a while until she builds up her energy levels.

We have been through so much, It started off as a tummy bug, well I though it was one because it was going round the class. All of her classmates were sick. But one by one they were going back to school but she was still throwing up. I would've taken her into hospital sooner (after three days) but my husband was in France and her sickness was worse at night so I didn't like to wake her twin brother to haul us all into A & E although now I bloody wish I had done!!!!

I keep remembering snippets of the day we were admitted, it was scary stuff as she was really sick. nurses rushing in and out of the ward. Surgeons on stand by in theatre while they pumped her full of fluids.

Onwards and upwards eh?

XXXx

[llhj]

Really dreadful luck. I wish her a speedy recovery.

[Chillywhippet]

Aw Stirrup it's so hard. It took my DD a while to recover physically and me ages to get over it emotionally. It's so hard not to beat yourself up with hindsight

My DD had atypical appendicitis in that she was ill on and off over a 4 month period. She was admitted to hospital 3 times but always on the weekend so it took an eternity for a consultant to see her with juniors trying to make decisions. Not enough surgical cover at our large district general hospital on the weekends.

The last episode was on a Sunday morning and she was lying on the bathroom floor puking bile. I actually said to her, "oh no it's a weekend."

We got to the hospital and there was much rushing around with staff saying things like, "She looks toxic to me." "I can't get a line in." "I think she's shutting down." It turns out she was bleeding internally.After the surgery the consultant said her abdoman was full of blood from a heamoraging appendix and they did a wash out etc.

DD said to me afterwards, "Why did you send me to school in pain? Why didn't you believe me?" Every time she was seen by a doctor they would say, "How is school Chillygirl?" She would say, "I hate it." the doctors took this to be an explanation for the tummy ache, definitely not appendicitis.

DH and I were really troubled afterwards by what might have happened on days we left her at home when we went on chores or popped to work. I work in the NHS and even now, a few years later, when A&E is full and an alert pops up on everyone's computer, I get a memory about being in a busy A&E with my poorly girl and my stomach does a horrible flip.

Sorry if that's too much information about us but I wanted to say you have been through a traumatic experience and you may find that your mind goes over stuff as you process what has happened to you all.

[llhj]

I'm grateful to you both for sharing your experiences. It's good to be vigilant.

[Lindy2]

How horrible for you all. I'm glad she is on the mend.
I had my appendix removed a few years ago. Nothing like as bad as your daughter but a 10 cm cut and awful antibiotics afterwards as it had burst.
I was absolutely wiped out afterwards even though I healed with no complications. It took about 2 weeks to have any strength at all.
I would suggest you take it slowly. She will be tired and probably a bit traumatised for a while yet.

[stirrupleathers]

Oh my Lord Chillywhippet, I also sent my daughter into school with I now realise was a rumbling appendix. I thought she was having me on ! I feel awful every time I think about it. Her consultants all said that its very difficult to diagnose an appendix so a sickness bug could mask it.

My daughter was also r throwing up a bile liquid, brownish in colour. I know now that it was because her bowel was blocked due to the infection in her tummy from her ruptured appendix. They also struggled to get a line in as all her veins collapsed. They eventually found a vein in her foot.

The next day in CICU a few of the nurses that had prepared her for surgery found me and gave me huge hugs. They were as shocked as I was....:(

[Chillywhippet]

Apparently there are 120 possible causes of abdo pain in girls. maybe a slight exaggeration but it is apparently one of the reasons appendicitis is so difficult to diagnose.

I think we are so programmed to keep our kids safe that when something really frightening happens we just go over it in our minds. My friends little boy had minor injuries after being run over. He just ran out in front of the car to see his friend. His mum was a bit traumatised for a while it they have both recovered now.

All the best with both your recoveries

[dratsea]

Stirrup and Chilly Do not beat yourselves up. When I was a senior trainee (I hate the term junior doctor, I was then in my mid thirties) and our surgical ward was full, I was checking up on a surgical admission on one of the medical wards. The very nice ward sister took me to my patient and as we walked back to her office passed a moribund child in the high dependency bed next to nurses station. I asked the sister what the problem was and poor girl, also just under ten, was admitted a week earlier with a severe tummy bug and was still needing an IVI for hydration. I asked the sister if the mother would mind if I looked at her child. I wrote in the notes that I thought the sepsis probably had an underlying surgical cause and would be happy to return formally to give advice if requested. The child was under the care of the professor of paediatrics and it was not until the next day that my consultant told me the exchange that had taken place at the highest level. But the result was that I was called back and that evening removed a couple of grams of not too manky appendix and a couple of kilos of the most foul pus I ever had the misfortune to smell.

Just curious, and I am now retired, but this girl was tiny, the smallest in her year. I have noticed several other late diagnoses in such children and used to put this in my talks to GPs and trainees. "Beware the slow to respond D&V in the smallest child in her class"

And final thought to Stirrup the healing process after such an illness needs a huge amount of calories, minerals and vitamins etc. Do not be surprised if she manages to put away five meals a day for the next couple of months.

[stirrupleathers]

Dratsea, my daughter isn't the smallest in her year, however she's a prem baby born at 33 weeks. Not sure if that's relevant. Thanks so much for your messages. Funnily enough she's eating so much, I was worried she'd balloon! But I guess after being nil by mouth for three weeks she's trying to catch up, plus her body is healing. Can I ask one question? If she's moved around a lot she gets pain down both sides of her tummy. I tell her to rest when she tells me, I'd be interested to know what you think?

[dratsea]

I have no idea if being prem has anything to do with it. I suppose prems do tend to be on the small size for the first few years and the school year is based on date of actual birth rather than EDD. Could that be a link? As for the cause of pains again I have no idea but doubt that it is anything serious. Everything inside her will be really gummed up with a lot of re-organising on going. In my brain I have an image of all the loops jostling each other, a bit like passengers on the tube in the rush hour.