The Appendix: 5 Common Questions

More than 700 kids are treated for appendicitis at CHOC Children’s every year. The appendectomy is one of the most commonly performed surgeries in the world. But just what is the appendix, and why does it send so many people to the emergency room with stomach pain?

Dr. Peter Yu, CHOC Children’s pediatric general and thoracic surgeon, explains everything you’ve ever wondered about the appendix, and more.

Dr. Peter Yu, pediatric general and thoracic surgeon at CHOC Children’s


  1. What does the appendix do?

The appendix is a small, finger-like projection that sticks out of the large intestine, located in the right side of the abdomen. It weighs about as much as an earthworm. In fact, its old-fashioned name is vermiform appendix, which means worm-like, Dr. Yu explains.

Everyone’s appendix is different. Some are long, some are short and stubby. But one thing they all have in common is that they are not necessary for a happy, healthy life.

“We are not sure if the appendix has a purpose. Some doctors don’t believe it does anything,” Dr. Yu says. “Some think it plays a role in the development of the immune system, and some believe it harbors ‘good bacteria’ that helps intestinal health. The bottom line, though, is that appendicitis is common, and patients do extremely well after removal of their appendix.”

  1. What causes appendicitis?

Bacteria naturally live in the large intestine and flow in and out of the appendix. Sometimes, the opening to the appendix gets blocked. Either constipation, a hard piece of stool called a “fecalith,” or enlarged lymph nodes cause these blockages.

The blockage traps the bacteria inside where it festers and multiplies. This leads to inflammation of the organ. If left untreated, the appendix can burst, releasing the infectious bacteria into the body.

Symptoms of a Burst or Inflamed Appendix

What are signs of appendicitis?

  • sudden severe pain
  • pain that starts near the belly button and moves to the lower abdomen on the right side
  • fever, nausea or vomiting

To diagnose appendicitis, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital will check your child’s blood for signs of an infection and will do an ultrasound of the abdomen. While many hospitals use a CT scan to diagnose appendicitis, CHOC radiologists and sonographers have the training and experience to make a diagnosis using ultrasound, in order to minimize your child’s exposure to radiation. If the ultrasound is inconclusive, the radiologist may conduct a CT scan.

  1. How does the surgeon remove the appendix?

The surgeon will perform a procedure called a laparoscopic appendectomy to remove the appendix. A pediatric anesthesiologist will put your child to sleep using general anesthesia. The procedure takes about 30 minutes, though CHOC’s pediatric general surgeons can remove the organ in less than 10 minutes if needed.

During surgery, three tiny incisions are made on the abdomen. Carbon dioxide is blown into the belly to create a dome, giving the surgeon room to work. Small surgical tools are inserted in two of the incisions and a laparoscopic camera is inserted in the third. The appendix is identified, stapled or tied off, and removed.

The surgeon closes the incisions with surgical glue and dissolvable strips. In most cases, children will stay in the hospital for one day before the doctor discharges them. They should have no heavy activity or sports for two weeks after surgery and can usually return to school quickly, often even the next day.

  1. What do you do with the appendix after you take it out?

Pathologists then inspect the removed appendix in the pathology department under a microscope. This inspection is important because it will confirm the diagnosis of appendicitis and rule out other conditions such as ulcerative colitis, Crohn’s disease and carcinoid. Your surgeon will update you with the results during your follow-up appointment.

  1. What if my appendix bursts?

“Fortunately, perforated appendicitis is less common than non-perforated appendicitis, but it can happen,” Dr. Yu says. “For some, the appendix can burst quickly, and for others it does not burst at all. There are many factors that a surgeon will consider before deciding whether to operate immediately, or to wait.”

If your surgeon decides to wait, then treatment can include antibiotics, placement of a drain in the abdomen, and nutrition through an IV if needed. Most patients improve in several days, after which the doctor discharges them. Your surgeon will then schedule your child for an interval appendectomy, which is removal of the appendix 8-12 weeks later. This gives the body time to recover from the infection and inflammation, making surgery safer and less complicated.

The CHOC Emergency Department, equipped to treat appendicitis 24 hours a day, with pediatric surgeons ready for all situations is mainly for kids and teens.

Learn more about appendicitis in kids and teens

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An Unexpected Case of Appendicitis: Jordan’s Story

Six-year-old Jordan was enjoying a fun break with his family in Big Bear, Calif. when he started complaining of stomach pains one afternoon. He had no chronic conditions or other symptoms, so his family didn’t immediately think it was anything serious. They assumed it might be a stomach virus, and never imagined that he would need to undergo surgery at CHOC Children’s a mere 24 hours later.

stomach pain or appendicits
When Jordan complain of stomach pains while on vacation with his family, they never image he’d undergo surgery a mere 24 hours later.

Late that night Jordan was in tremendous pain, so his parents took him to an emergency room near their resort. Two local physicians ruled out anything serious. They told Jordan’s parents it was likely just constipation or gas, and sent Jordan home.

“We were wary of the diagnosis received and being vigilant, we cut our family vacation short and rushed home so we could be closer to CHOC if his condition worsened,” says Jordan’s mom, Emma.

His pain became unbearable overnight.

“We knew his pain was abnormal and didn’t want to take any more chances at any local hospital. I wanted to know my son was in a place that specializes in kids.”

An accurate and timely diagnosis at CHOC

Testing in the ED immediately revealed that Jordan had a unique case of appendicitis with ileo-colic intussusception (a condition where part of the intestine folds into itself, like a collapsing telescope), and would undergo surgery that same day.

“Appendicitis is the most common reason for abdominal surgery in children. Pediatric surgeons at CHOC saw over 700 cases of appendicitis last year,” says Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC. “Many of these patients first come through the emergency department, meaning our ED staff is well-versed in both classic and non-traditional symptoms of appendicitis, and very unlikely to miss a diagnosis. Also, when we discover unusual variations associated with common childhood illnesses, such as ileocolic intussusception with acute appendicitis, the pediatric surgeons here are prepared to deal with it.”

Surgery at a Place Designed Just for Kids

Receiving a correct diagnosis faster meant that Jordan was on his way to surgery before his symptoms worsened.

“Jordan’s parents made a good decision in bringing him straight to CHOC,” says Dr. Yu. “If they had gone to an ‘adult’ hospital first, they would likely have been transferred to CHOC for surgery anyway.  This can be costly, delays care, and can be a huge inconvenience for families.”

Learning that your child needs surgery can be scary for parents to hear. But thanks to Jordan’s parents’ decision to bring him to a hospital that only treats kids, Jordan was under the care of pediatric-trained specialists using equipment that’s made just for kids.

CHOC has pediatric surgeons on call 24/7, meaning there is always a pediatric-trained specialist ready to treat your child, no matter what time of day or night your child needs surgery.

“These events are extremely stressful as a parent because while we are still digesting the diagnosis, we need to ensure we make sound decisions in a short amount of time,” says Emma. “Dr. Yu was patient and very thorough, and I knew there was no one else I would rather have care for my son.  He was in excellent hands. We were probably his last surgery of the day but he made us feel like we were his first.

After making the decision to return to CHOC for Jordan’s correct diagnosis and surgery, their son was not only in the hands of a pediatric surgeon, but a pediatric anesthesiologist as well.

“Although, an appendectomy is one of the less invasive surgeries a child can undergo, as a parent you’re still very much concerned of the potential issues that could arise from going under anesthesia,” Emma recalls. “Knowing he was under the care of an anesthesiologist who specializes in children was a great comfort to my husband and me. After we met with his surgery team, we knew he was in the best hands possible.”

stomach pain or appendicitis
Jordan and his pediatric surgeon., Dr. Peter Yu.

Healing faster in an environment just for kids

Jordan sailed through surgery with flying colors. His appendectomy was done via a single incision hidden in his belly button, meaning he will have minimal to no scarring after surgery. His intussusception self-resolved and needed no additional surgical intervention.

After surgery, Jordan only needed to stay at CHOC for one night for observation, but he had so much fun that he would have stayed even longer if he could have, Emma recalls.

“Jordan loved being at the hospital because he felt like he was the boss! Everyone was so attentive to him. Every person that we interacted with, from the nurses that cared for him and spoke in a way he would understand, to the volunteer in the play room that let Jordan teach him how to play chess, helped make CHOC a kid-friendly place. I know any fear of doctors, hospitals and surgery that Jordan had were all lessened because of this environment.”

stomach pain or appendicitis
Jordan only had to spend one night in the hospital after his emergency surgery for appendicitis. In that time, he benefited from the generosity of a volunteer in one of the hospital’s play rooms, who let Jordan teach him how to play chess.

Jordan spent a few days resting at home and was back at school the following week.

“Dr. Yu helped get us through this high-stress situation with our son with the amount of professionalism and care you would ever want in a scary time. He is hands down one of the best. We’ll be forever grateful to Dr. Yu!” says Emma. “Now that I know how wonderful the emergency department and entire staff is at CHOC, I won’t take my kids anywhere else.”

Get answers to parents’ frequently asked questions about surgery

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Landon’s Life-Saving Jejunal Atresia Surgery

Lizette Lough, experiencing a seemingly normal pregnancy, was making final preparations to welcome her first baby, when her water unexpectedly broke at 33 weeks. She was rushed to San Antonio Regional Hospital in Upland, close to home, where her son Landon was born early on May 3, 2016.

After a few days in the hospital, Lizette and her husband Sean noticed the baby had not made a bowel movement. Tests revealed that Landon had an obstruction in his intestine. His physician recommended Landon be transferred immediately to CHOC for an emergency surgery with Dr. Peter Yu, a pediatric general and thoracic surgeon.

“My husband and I lost it,” Lizette says. “Our baby was only three days old and weighed about 4 pounds. The thought of surgery was beyond frightening.”

Upon arrival at CHOC, the Loughs were immediately made to feel at home by the staff, who helped them find a nearby hotel. Dr. Yu explained every scenario of the complex surgery in a compassionate and confident manner, the Loughs recall.

Jejunal atresia
Landon was born at 33 weeks and diagnosed with jejunal atresia, despite prenatal genetic testing and a healthy pregnancy.

“Landon was in stable condition when he arrived at CHOC, and I’m very pleased that our expert transport team was able to get him here quickly and safely. If there had been a delay in transfer, Landon could have become very sick and it’s very possible that more of his intestine could have died. If that would’ve happened, he may not have had enough bowel to adequately digest food, which can be incompatible with life,” Dr. Yu says.

Landon was diagnosed with jejunal atresia, a rare condition – approximately 1 in 5,000 births – in which the small intestine is incompletely developed, leading to one or more gaps, or blockages, in the intestinal tract.

Lizette had gone through the required genetic tests prior to Landon’s birth, and jejunal atresia – often diagnosed prenatally – was not detected.

Additionally, Landon had malrotation of his intestines, which failed to coil in the proper position in the abdomen. This led to twisting of his bowel. If surgery had been delayed for longer, Landon could have died.

Landon’s surgery involved making an incision on his abdomen, examining the entire length of his intestine and untwisting it, removing the dead bowel, stitching together his small intestine, and performing a Ladd’s procedure. A Ladd’s procedure places the intestines back into the abdomen in a safe configuration to prevent future twisting of the bowel.

jejunal atresia
Landon and his dad Sean in the surgical NICU at CHOC after Landon’s jejunal atresia surgery

Sean, who works as a law enforcement officer, recalls how traumatic this was for his family. “I’m used to working in stressful situations, but this was a different kind of stress,” he says. “We were so happy that our baby had a successful surgery and that he was better. However, we were still waiting for him to have his first bowel movement. We were trying to stay positive.”

After his first bowel movement indicated that his intestines were recovering well, and spending about a month in CHOC’s surgical NICU, Landon was finally able to go home with his family.

jejunal atresia
Landon and his mom Lizette during his first feeding, which took place in the surgical NICU at CHOC after his jejunal atresia surgery

“It takes a team to successfully care for sick babies and complex patients,” Dr. Yu explains. “Landon would not have had the excellent outcome that he had without our wonderful neonatologists, experienced and skilled pediatric anesthesiologists, Melissa Powell, our dedicated surgical neonatal nurse practitioner, and the outstanding NICU nurses who have dedicated their lives to taking care of newborn babies such as Landon and countless others. Together, we have the only dedicated surgical NICU in the area, with a special focus on taking care of newborns with surgical problems.”

Thanks to the expert multidisciplinary care provided at CHOC, today Landon is a happy baby, meeting all his milestones. The Loughs are enjoying their brave little boy, and look forward to his first birthday next month.

jejunal atresia
Landon is looking forward to celebrating his first birthday at home with his parents.

“Dr. Yu and the nurses in the NICU were so empathetic and amazing. They saw us through so much throughout our stay and we will forever be thankful,” Lizette says.

Find a CHOC pediatric surgeon

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10 Questions to Ask Your Child’s Anesthesiologist

By Dr. Eric Ontiveros,  chair of pediatric anesthesiology at CHOC Children’s

You want to know your child who needs surgery is in the best hands. Kids’ bodies are completely different inside, and pediatric specialists know the difference. Pediatric anesthesiologists at CHOC Children’s, who lead your child’s surgery team, have compiled a list of questions commonly asked before surgery. Any question about your child is a good question. If there is ever anything you do not understand, ask your child’s surgery team.  They are there to help.

Am I allowed to be with my child before surgery? If so, for how long?

Before surgery, you and your child will be taken to the pre-operative unit, or “pre-op.”  A nurse will review the information needed to safely perform the child’s procedure. The surgeon and the anesthesiologist will evaluate your child and answer any questions you have. You will be asked to sign any necessary paperwork and then accompany the child to the operating room doors. After another hug and kiss, the team will assume care of your child.

Am I allowed to be with my child while anesthesia is being given?

You child’s safety is our biggest priority. Having a parent in the operating room can distract the team’s focus away from your child. To ensure the safest environment possible for your child, you will be taken to the waiting room.

Will my child have pain when getting an IV?

Depending on the child’s age and planned procedure, we may start an IV in the pre-op unit. An IV is a small plastic tube inserted into the vein and  used to deliver medication. Depending on the age of your child, a small amount of anti-anxiety medicine may be given orally before placement of the IV. The staff will also use special numbing medicine to reduce the discomfort of IV insertion. A child life specialist will provide age-appropriate distractions such as books, games, or bubbles to aid in the process.

What kind of anesthesia will my child be given?

Anesthesia is broken down into three main categories: General, Regional, and Local.

General anesthesia makes and keeps a person completely unconscious (or “asleep”) during the operation. It can be administered through an IV, or by inhaling an anesthesia gas delivered by mask.

Regional anesthesia is when a drug is injected near the spinal cord, numbing a large area of the body. An example is an epidural. It is often combined with general anesthesia in kids and used for pain control after the surgery.

Local anesthesia numbs a small, specific area of the body- for example, a foot, hand or patch of skin. It can be given as a shot, spray or ointment. Local anesthesia is often used to reduce the pain after surgery.

The anesthesia your child receives is tailored to their needs and depends on factors including:

  • The type of surgery
  • The location of the surgery (hospital, outpatient surgery center or doctor’s office)
  • How long the surgery will take
  • Current and previous medical condition
  • Previous reactions to anesthesia (in your child or family members)
  • Medications your child is currently taking
  • Age, height and weight

No matter which type of anesthesia your child receives, your anesthesiologist will be available before, during and after the operation to monitor the medications your child receives and ensure they are receiving the right amounts.

Will my child be sedated before anesthesia is given?

Your child may receive medication to help them remain calm and feel sleepy before the procedure or surgery. This medication is usually given by mouth and before starting the IV. Many children are curious about the operating room and prefer to experience falling asleep in the OR, so they skip the sedative.

Will my child still have an IV in or be hooked up to any monitors or equipment after surgery is over?

Your child will usually wake up with their IV in place. This is helpful as additional medications are sometimes needed to treat pain or nausea. Your child will also wake up with several monitors that help the anesthesiologists and nurses monitor your child’s recovery from anesthesia. These monitor blood pressure, heart rate and oxygen levels. As your child recovers from anesthesia, the IV and monitors will be removed.

How long will it take my child to fully wake up from general anesthesia?

The anesthesiologist will begin to “wake up” your child after the surgery is completed. This amount of time varies from child to child and is dependent on their medical history and type of surgery performed. This can take up to an hour, and most children wake up in the recovery room (also referred to as the post anesthesia care unit, or PACU) in a shorter amount of time. Full recovery can take up to several hours.

How soon after the surgery can I see my child?

After the surgery is completed, the surgeon will speak with you in the Tidwell Procedure Center lobby. It may take an additional 20 to 30 minutes for the nursing staff and anesthesiologist to recover your child from anesthesia before having you enter the recovery room (PACU).

How soon after the surgery can my child eat, drink, go to school, or drive [if you have a teen]?

If your child is going home after surgery, the nurse will offer your child a snack and drink in the recovery room. No driving for teens the day of surgery. The surgeon will provide a school note if time off is required. If a hospital stay is required, and depending on the procedure, the surgeon will order the appropriate diet.

How soon after the surgery can my child go home?

Children usually spend 30-90 minutes in the recovery room. Patients heading home will be provided a discharge plan. This plan may include instructions on how to take care of the operative site, what medications to take, what your child should eat that day, and what activities the child may participate in. It will also have instructions on what to look out for and when to call the doctor. Download a copy of the discharge questions worksheet.

You will receive a phone call from a CHOC nurse within 72 hours of the patient’s discharge from the hospital. Our nurse will ask about how the child is feeling and will be able to answer any additional questions you may have.

Download these questions and answers.

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A Road Map to Surgery at CHOC Children’s

Having surgery at a hospital can be a scary thought for children and parents, alike.  Knowing what to expect can help alleviate fear and anxiety.  The photos below highlight some key aspects of the patient and family journey through the Tidwell Procedure Center at CHOC Children’s Hospital.

surgery at choc

Welcome to CHOC Children’s Hospital – a hospital for children and teens, only. When a child requires surgery, his needs are different than an adult. CHOC has specialized in pediatric surgery since we welcomed our first patient in 1964. Today, our nationally recognized surgeons perform the latest procedures using equipment customized to pediatric patients, from newborns to adolescents.

surgery at choc

After checking in at our first floor lobby, surgical patients and their families are directed to our Tidwell Procedure Center, which includes seven operating rooms, five procedure rooms and two cardiac catheterization labs. The Center boasts leading-edge technology and safety features, as well as a calm, healing environment. Here’s the Center’s bright, colorful lobby, featuring natural light, bubble columns and interesting artwork. There’s also a family room and playroom.

surgery at choc

We want our patients and their siblings to still have the opportunity to act like kids while facing the adult issues of surgery. In addition to a playroom in the lobby, we have an area for play, stocked with books and toys in pre-op. Dedicated child life specialists help normalize the experience by making the environment less strange. Providing distraction and developmentally appropriate education, child life specialists are important members of the surgical team.

surgery at choc

Child life specialists are at the bedside to provide developmentally appropriate education. Patients are able to see pictures of the operating rooms on iPads, which helps to limit stress and anxiety without the use of medication.

surgery at choc

Before heading into the operating room, patients stop at what is affectionately called the “kissing spot.” Here’s where they can say “see you later” to their loved ones before “taking a nap” for surgery.

surgery at choc

Child life specialists escort patients into the operating rooms and to provide distraction and emotional support while pediatric anesthesiologists and other staff members prepare patients for surgery.

surgery at choc

Following surgery, patients recover in our PACU (post anesthesia care unit). As soon as the patient is stabilized, parents/legal guardians are escorted into the area. During this time, patients need as much rest as possible to help their bodies heal and give pain medication time to take effect. The environment is kept calm and quiet. From here, the patient will either be taken to a hospital room, or discharged home.

Our physicians, nurses and staff are dedicated to getting kids better and back to their normal activities as quickly as possible. Patients and families are our partners in this effort; knowing what to expect before, during and after surgery can make a big difference on the experience and recovery. For more information, visit

Take a virtual tour of the Tidwell Procedure Center

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