Colonoscopy is preferred for evaluating colon involvement, followed by an upper GI series with small-bowel follow through. Treatment - Children with IBD may require both medical and surgical intervention and are best managed by a gastroenterologist who can coordinate medication, nutritional supplementation, and surgical intervention. Appendicitis - Appendicitis occurs when there is an obstruction of the appendix. Hardened fecal material, foreign bodies, micro-organisms or parasites may cause obstruction, as well as, hyperplasia of the submucosal lymphoid tissue, kinking caused by a congenital peritoneal fold or fibrous stenosis from an earlier inflammation or tumor. The acute obstruction blocks the normal flow of mucus causing a build up of pressure in the lumen which results in compression of the blood vessels and ischemia.
Subsequent necrosis causes perforation resulting in contamination of the abdomen and peritonitis.
The most common symptoms are colicky abdominal pain and tenderness which is generalized or periumbilical at first. As the condition progresses, pain becomes localized, usually to the lower right quadrant, severe and constant. Nausea, vomiting and anorexia occur after the pain starts. Some children present with vague symptoms that make it difficult to confirm a diagnosis, even so, appendicitis should not be ignored as a diagnosis until eliminated by careful examination. Intussusception - a telescoping of the intestine that causes edema and a reduced blood flow to the intestinal wall.