To think I'm right and the doctors are wrong?

[Rabbitpoop]

DD is 13yo and has had really bad nausea and stomach ache for 10 days. Shes been off school the whole time and very little appetite. GP thought it was appendix related so sent us to hospital. First surgeon admitted us and said seems like appendix as she only has pain in the exact area of the appendix. Put us on the list for surgery.

Saw another surgeon who said he wanted an ultrasound first. Fair enough. They couldn't see her appendix during the scan but no obvious signs of anything else wrong so surgeon passed us to paeds.

Paediatrician came in and said it is constipation before he even examined her. She isn't constipated at all and the pain is only on the bottom right side in a specific area. I questioned him and pushed back quite a lot as I'm 100% sure this is not constipation. She's had no change in her bowel movements. Paeds said there's no sign of appendicitis in her blood tests so it's unlikely to be appendicitis.

I looked up the NICE guidelines and it says that you can't rule out appendicitis by blood test or ultrasound and that it can present differently in different people. It seems the only real way of telling is laparoscopy/surgery but the surgeons won't do it as she's not writhing in pain.

I don't know what to do. I'm sure it's not constipation and that it's something to do with her appendix. They said they wouldn't give antibiotics either as there's no sign of infection.

I'm worried they're just going to tell us to go home and she'll continue to be off school, feeling sick, barely eating and with a stomach ache.

Any advice?

Just seen a different surgeon who says that her history warrants investigation so looks like they are going to do a laparoscopy/appendectomy. Feel much more confident in this doctor as he actually took the time to listen to what we were saying. I saw in her notes that it said her pain had gone away earlier in the day, which isn't true at all. I've no idea why it says that. Thank you for all the advice, it gave me the confidence to keep questioning.

The Drs were pretty sure my son had appendicitis from his bloods. Elevated markers.

Appendicitis signs can also be, unable to weight bear on one leg and pain in the tip of the shoulder! Who knew!

I had appendicitis last year and the pain was excruciating. I was wheeled around the hospital by a porter because walking was barely possible, as was moving from sitting to lying down.
I really hope the surgery finds the cause of the pain and that your daughter recovers quickly!
In response to a couple of comments I've seen on here... An appendectomy will be performed if the symptoms of appendicitis are present, even if the doctors aren't 100% sure that it IS that. This is because the risks of an appendectomy are lower than the risks of the appendix bursting.
Also, an ultrasound isn't very accurate when diagnosing appendicitis. When I was in hospital, I was given the choice of an ultrasound or a CT scan because of this. I chose the latter and had surgery the next day, thankfully!

Glad to see your update, fingers crossed they get to the bottom of things tomorrow.

Has she recently had Covid OP? Children that age are sometimes presenting with abdominal pain mimicking appendicitis but it's a post covid inflammatory response.
It's good that you keep getting her seen and sorted out but I don't think they are in the wrong for not going to surgery straight away. Hope she is sorted soon

Thanks. I don't think the doctors were in the wrong for not jumping straight to surgery, but for dismissing her symptoms and saying it is constipation when she has no signs or symptoms of constipation. I guess it's just the difference between feeling that a doctor is listening to the patient or not.

No she had covid twice last year but hasn't had it recently.

Mesenteric adenitis.

My DD was admitted for 3 days and they were convinced she had appendicitis. She couldn't hop or anything. They were talking about surgery etc. Then all of a sudden they decided to discharge her with mesenteric adenitis. I wasn't convinced by the massive turn around. But they were obviously right! She still gets tummy ache in this spot when she's run down or has an infection. When I think back to her toddler years, she was the same.

And yes. It is in the same spot. The first Dr told me her was 100% convinced it was her appendix.

Might be mesenteric adenitis. My son had this. We thought it was appendicitis and he was hospitalised while they chevked

If it’s any consolation my daughter was like this for a month. They put it down to a bug.

Bacterial gastroenteritis?

I think mesenteric adenitis would be excluded by the ultrasound?

It's really difficult, I think. I had several admissions to hospital as a teen with ?appendicitis. They eventually decided to remove it and said that it was perfectly normal. The strange thing is that I never got that pain again.

It may be appendicitis but if the infection markers aren't high and it has been going on 10 days, then they do have to weigh up what is the most sensible course of action.

I had an emergency appendectomy a few years ago. My daughter got bad stomach pains a few months later and was vomiting. She was 9. We hung about in hospital for a few days until we saw a different consultant.

She asked my daughter to stand on the floor and do 3 quick jumps as high as she could in quick succession. She could do it so the consultant discharged her. She was fine after a few days.

When I had appendicitis any movement was agony and I had to hold my stomach to protect it from the vibrations so it made sense. The consultant said if she had appendicitis she wouldn't have been able to do the jumping.
Hope she's better soon.

I would put it down to stress. Appendix issues are quite specific in terms of the location of the pain, and if symptoms were presenting your dr would offer further tests.

They have reasons for every decision. My daughter had big digestive problems and we were confused too. But she was constipated and had impacted faeces . This is a big deal and must be treated before moving forward. Do mention your findings to the decontrol though. Might be of some help. Good luck. Teenage years can be so difficult x

@incognitoforthisone

I think I'd be inclined to reiterate the NICE guidelines, firmly, or get an emergency appointment with the GP for another referral. Or go straight to A&E with her. You must be really worried and she must be feeling rotten.

There is just one more thing I might consider ... Is it possible your DD is having some kind of anxiety re. school or friendships, by any chance? Stomach pain and nausea without any obvious cause are a classic symptom of anxiety. And it's also very easy for a 13-year-old to Google 'symptoms of appendicitis' if there's some reason they're scared to go to school. I'm not in any way trying to disparage your DD here, but she's only a kid and sometimes when kids are really, really worried about something they will resort to quite desperate measures. It is just an idea though and frankly I'd feel as much sympathy for her if this were the case as I would if she has appendicitis, poor thing.

I had this as a teenager- started at 13 and didn’t completely go until I was 19. I didn’t even know it was anxiety; I was (and my family were) convinced I was very unwell.

I hope you get to the bottom of this.

@GirlOfTudor

In response to your comment, mainly cos my knickers get in a bit of a twist about imaging modalities.

Sorry but you’re not quite right.

1. Ultrasound is actually very useful in children in diagnosing appendicitis and excluding appendicitis. Less so in adults.

In addition CT carries a radiation (therefore future cancer risk) that is often deemed unacceptable in many cases with children that’s why they get an US and in some centres an MRI if the US is equivocal.

Although CT can be helpful if the diagnosis is unclear as it’s a good modality to pick up the mimics of appendicitis.

1. A number of large studies have now shown that a negative CRP and WCC 24 hours after symptom onset is at least 97% (some even cute 100%) negative prognostic value for appendicitis I.e it’s pretty good at excluding it.

But obviously everybody worries about the tiny percentage that will be missed particularly if the patient isn’t understanding as nobody wants to get sued.

1. During the pandemic many people of all ages with uncomplicated and complicated appendicitis were treated with just antibiotics and no appendicectomy with good outcomes and lower complication rates. The omentum is pretty good at it’s job even in perforated appendicitis.

This is obviously not the population that have appendicitis secondary to appendiceal/cecal tumour which tends to be the older population.

1. Although complication rates of appendicectomy are low, many studies only look to one year out comes which largely misses people coming back many years later with adhesions secondary to surgery that can cause big problems. Obviously, there’s an argument for the inflammation alone to cause adhesions so it’s tricky to unpick that argument.

However, there’s a reason many doctors including surgeons say ‘avoid the surgeons knife and you’ll live a long and healthy life’.

In conclusion, appropriate clinical assessment, blood results and ultrasound combined are very good for assessing appendicitis likelihood in children. People are often scared of missing the tiny percentage that can’t be ruled out by these as nothing is ever gaurenteed hence the super high negative appendicectomy rate when the sample is sent to histology.

P.S in the UK we call it an appendicectomy not an appendectomy.

OP I hope you daughter is okay and you get a diagnosis and quick recovery soon

Dd has Polycystic ovaries.
She took her period very young (9)
She has this pain every month due to multiple cysts.
May be worth pushing this idea an ultrasound will show them.

My son aged 4 was hospitalised for a week in sick kids with this exact scenario. He was constantly vomiting bile, very pale, temp and drowsy. I was convinced appendix as were the Dr's. Ultrasound didn't see appendix (meaning small and healthy!) and nothing else of concern. I remember crying to a Dr because I was so sure it was appendicitis. They were amazing and said it was mesenteric adenitis wich I disputed and fully expected him to be back within days with a rupture. Turns out... 18mths later. They were right and I was wrong!

There are many meta-analysis out there on the predictive negative value of normal WCC and CRP in acute appendicitis especially this far on I. The clinical course. NICE guidance is often quite far behind the evidence.

It's probably one of the reasons that they're finally moving to the living guidelines approach. Given how common the issue of appendicitis or not is, so to speak, I'd hope that this is among the first batch to be converted to a living guidelines approach rather than the usual quite lengthy update schedule.

We've been there with this. Along with very severe pain and vomiting. She was admitted for overnight observation. It wasn't appendicitis. Two years later still hospital outpatient and no discernable cause. She may have appendix out eventually as this has been known to resolve the issue.

All surgery has risks and GPs often refer for suspected appendicitis as it's hard for them to diagnose and consequences of getting it wrong are severe
Suggest you ask is she can be admitted for observation.

Bless her, she must be exhausted and feeling awful. I hope they find out what’s wrong with her soon. If it is her appendix in a way it’s good, whip it out and she will soon be back to normal.

Would mesenteric adenitis cause pain only in the appendix area (can't remember the fancy word they used, sounds like someone's name)?

Was it mittelschmerz pain that the dr mentioned, @Rabbitpoop? All the very best to your DD. I hope you get some answers soon

www.nhs.uk/conditions/ovulation-pain/?