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My 2 year old daughter presented with lethargy, fever,

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vomiting, pain in the abdomen...
My 2 year old daughter presented with lethargy, fever, vomiting, pain in the abdomen, and loss of appetite on September 13. The vomiting ceased on September 14 but the fever, abdominal pain, lethargy, and lack of appetite persisted. On September 23 (our 10th hospital visit) an ultrasound was finally done and 3 abscesses were found; 2 small ones by by the liver and a 27x25mm ring enhancing fluid collection at the location of the appendix. A drain was put in the 27x25mm pocket. The appendix was not visible under the ultrasound or CT scan. Cultures of the pus were removed and preliminary reports indicate the bacteria originated from the bowel. I was told by the doctor that it is very likely that my daughter's appendix ruptured and then the abscesses formed. She was placed on IV antibiotics for 6 days and tomorrow will changes to oral antibiotics for 5 days. The drain will be removed. They will be doing a ultrasound tomorrow and discharging her from hospital. My question is, 'Is surgery to remove the ruptured appendix not necessary?' And 'How do we really know she is better...since it ruptured is discharging her home on oral antibiotics the best course of action'. Keeping in mind we live 1 hour from the nearest (small rural hospital), 4 hours from the pediatric large hospital, and it takes at least 20 minutes for an ambulance to reach our house.
Submitted: 8 months ago.Category: Pediatrics
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Answered in 13 minutes by:
9/27/2017
Pediatrician: Dr. Su S., Pediatrician replied 8 months ago
Dr. Su S.
Dr. Su S., Pediatrician
Category: Pediatrics
Satisfied Customers: 22,706
Experience: 20 years of experience in treating children.
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Greetings,
Thank you for your question.
I am Dr. Su S.
I will try my best to help you.

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Pediatrician: Dr. Su S., Pediatrician replied 8 months ago

Thank you for waiting.
I am very sorry for her symptoms.
As she is being changed to oral antibiotic, it is likely that she has improved.
Orally fluid, food or medicine is only allowed when there is much improvement.
Surgery to remove appendix is necessary.
But in stage of infection, abscess formation, it has risk of complication.
So doctor is prescribing antibiotics to control infection.
Doctor would likely ask you for follow up visits.
Surgery can be taken weeks later.
I hope this information will be helpful.
If you have any query, please feel free to ask.
If you are happy with my answer please click on the Excellent/Good rating.
Wish her healthy life.
Regards.

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Customer reply replied 8 months ago
Ok so surgery to remove the appendix will be scheduled at a later date when the inflammation is gone and the appendix has softened, but how do I know she is better? She is still on pain meds (fever suppressants) right now. My concern is that after the 5 days of oral antibiotics what is her risk of having a relapse? Or put differently 'What exactly makes a doctor decide that a patient who's appendix ruptured is at a low risk of reinfection?' For example, my sister's appendix ruptured and she had to return to the hospital 2 times after because 'they didn't get it all'.
Pediatrician: Dr. Su S., Pediatrician replied 8 months ago

Has she been allowed to take fluid orally?
Is she passing stool/ flatus?
How is her temperature?

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Customer reply replied 8 months ago
She never presented with issues regarding oral fluid intake or BMs. From September 14 at noon she has drank adequate amounts of water/milk but wouldn't touch solid food of any kind. Now she drinks water/milk and takes a couple bites at meals (a significant change from her previous eating habits). She had and continues to have daily BMs (obviously now very infant like in smell/texture). As for fever she hasn't had one since being admitted to hospital on September 23 as she has been on a continuous schedule of Advil/Tylenol. Prior to admission she had a temperature when the Motrin we gave her (2x daily - morning and bedtime) wore off. Her fever always disappeared soon after Motrin was given but came back in the early afternoon. I have requested pain medication be stopped for this evening (last taken at 8:30pm) in an attempt to properly assess her pain/possibility of a fever in the AM.
Pediatrician: Dr. Su S., Pediatrician replied 8 months ago

As she is passing stool the intestine is moving which usually stops in an inflammation or infection of abdomen.

In addition to fever, doctor can monitor improvement by examining physically, monitoring vitals.

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