Post ruptured appendix complications

[mumof3madthings]

Hi There,
The story is long so I will try to summarise, but any advise or insight would be much appreciated!!
My 4 (v nearly 5) DD was unwell starting the last day of school before half term. By the Monday of half term she was really not herself, began vomiting early hours of Tuesday and then increasingly unwell with v high uncontrollable temp and general exhaustion. I repeatedly took her back to GP's, OOH,s and A&E. eventually by Friday they diagnosed a UTI despite three previous negative samples - her urine showed a small trace of leukocytes. 72hrs of co-amoxiclav later, and a doubled dose, no better. Finally admitted to hospital on the Monday where they discovered the bug was resistant to all oral antibiotics. Commenced IV antibiotics. 2 further days in and I kept pointing out she was unable to wee despite me making her drink loads and her abdomen was distending. Finally scanned her bladder/kidneys only to discover her abdomen was full of pus from a ruptured appendix. Consequently had surgery on Thursday night, open appendicectomy. Was left with a drain which was removed 3 days later. She did amazingly well throughout, hasn't complained at all. Remained in hospital for a further week as she had no oral option for antibiotics.
She has been through a lot, but in my opinion she still isn't right. My current concern is that now for the third time she has been unable to sense that she needed to do a poo and has had an accident, which was mortifying and so upsetting for her. She's a really sensible and self aware girl and has been potty trained with no accidents since 2.5. I really and truly believe her when she is saying she can't feel it coming. The latest was just now, she was moaning while asleep that her tummy hurt, when I went up to check she had had an accident :( I am aware of overflow diahorrea caused by constipation and am confident this isn't the issue.
We have a follow up on Tuesday (after much chasing) and I want to make sure I go to this appointment and come away with answers. She is still white and just not herself.
Sorry for the long post!! Thanks for any advise anyone can offer!

Your poor dd, what a trauma she's been through . Very little advice I'm afraid, but I will say that a neighbours dd had a ruptured appendix age 5. She was no way as sick as your dd (it was diagnosed within hours of rupturing) but it took fully 4 months before she was back to normal again. So, whatever is happening, it is early days yet for your dd.

Wrt the soiling, has she been able to control her bowels normally at all since the operation? Also, can I ask why you are confident it isn't constipation/overflow?

I would suspect she still has an infection and needs IV antibiotics asap. Does she have a fever? Have a look at the NICE traffic light guidance. Be aware of any changes in her condition.

She needs to be seen before Tuesday with her symptoms preferably by a paediatrician at A&E and by paediatric surgeons.

If you are at all worried please have her seen. Poor little thing. I hope you are ok, sounds awful for you all

It may be post antibiotics. As they were so strong all the gut bacteria will have gone which often causes loose stool.Could try probiotics/ bio yogurt etc to recolonise. Ask at her follow up too though.

I had similar as a young adult and wasn't right for months (very weak and run down). I needed readmitting for further antibiotics about two weeks after discharge as well. Was a rubbish time, feel sorry for your Dd and for her, for you.

I also had the same as a young adult and experienced a lack of warning of the need to poo. When I saw the surgeon for a follow up he said it was normal and that my bowel needed time to recover from the surgery as it was all linked. Definitely raise all your concerns with the doctor though. I hope she feels better soon, poor thing.

Thanks so much for the speedy and lovely replies!!
iPad has been crashing so I've typed this several times. Have also just seen the last post which is very reassuring! I'm hoping to be told all is normal, but just didn't want them to say, she's 4, maybe she has just regressed as I really don't think that it what it is at all.
Poos were loose but had normalised before discharge despite continued antibiotics. We did have lots of trips to the loo and plenty of false alarms, but never an accident until Tuesday this week.
As for probiotic, I had started her on one before admission as she had several start/stop courses of antibiotics in the build up (was tonsillitis before it was a UTI!?) and have recommenced it, so hopefully that will help.
Overflow - she hasn't eaten for nearly 4 weeks and so considering the amount coming out and the now normal consistency I was pretty sure there wasn't a backlog hanging around anywhere.
Appreciate it was all a big ordeal and perhaps I'm just expecting a bit much in terms of miraculous recovery, hence I wanted to check I wasn't being totally paranoid an neurotic :) however, I also now have a lot more faith in the gut feeling, so am still not sure.
Her temp has been consistently 36.4 other than an isolated spike of 37.4 on Wednesday (have been obsessively checking and even changed batteries as I couldn't believe it after weeks of 39.9!)
Will definitely present before Tuesday if anything in her condition changes. Thank you again for such helpful advice!

If you can get a sample of the diarrhoea it would be worth getting it tested to rule out C.difficile.

You poor thing, dd will be fine but you do need to visit on Tuesday. There is a surgical explanation for the minor temp and episodes of diarrhoea/accidents. Children do not get appendicitis under the age of 5, they get full blown generalised peritonitis and the mortality was appalling pre-antibiotics and pretty bad before u/s. Usually happens to smallest in peer group but that is an observation rather than a diagnostic tip. She is doing really well, and seems to have had fantastic care both from you and the hospital. Keep an eye on her temp, write it down each time, can you feel her pulse? (and that is harder than you would think in a 4yr old). That would be helpful to your surgeon too. She/he will be looking for persistent raised pulse, increasing before a spike in temp (above 39), lasting for just a few hours and the pattern repeating in 48hrs. It might also be worth noting her weight on your chart.

This is a rare disease, both you and dd are doing great and are over the worst.