The appendix is a small finger-shaped pouch on the right side of the abdomen, connected to the colon. Appendicitis is a condition where the appendix becomes swollen, inflamed, and filled with pus.
Experts are not sure what role the appendix carries out. Charles Darwin wondered whether it might have been an organ our ancestors used to digest fibrous plant material like tree bark.
Recent studies indicate that the appendix may be an area that hosts friendly bacteria which help digestion and fight infection.
Fast facts on appendicitis
Here are some key points about appendicitis. More detail and supporting information is in the main article.
- Scientists are still debating the function of the appendix
- Symptoms of appendicitis include a progressively worsening pain, nausea, and vomiting
- Often, surgery is the best course of action
- More than a quarter of a million Americans have an appendectomy each year
What causes appendicitis?
Experts believe there are two likely causes of appendicitis:
- Infection - a stomach infection may have found its way to the appendix.
- Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool might then infect the appendix.
Symptoms of appendicitis
Anyone who experiences a progressively worsening pain in the abdomen should seek medical attention.
Initially, some pain can be felt all across the stomach, but later on, as the infection progresses, the location of the pain becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney's point.
The following symptoms are common:
- Progressively worsening pain
- Coughing or sneezing is painful
- Inability to pass gas (break wind)
- Loss of appetite
Anybody who experiences a progressively worsening pain in the abdomen should seek medical attention. Other conditions may have similar symptoms, such as urinary tract infection; even so, they all require urgent medical attention.
Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms - the pain may not be classically located in the right lower quadrant of the abdomen.
Additionally, other conditions may have very similar symptoms, such as gastroenteritis, urinary tract infection, ectopic pregnancy, Crohn's disease, or a kidney stone.
Not everybody has their appendix in the same place - some are located behind the colon, behind the liver, or in the pelvis.
A doctor will examine the patient and ask some questions related to his/her symptoms. The doctor may apply pressure to the area to see if it worsens the pain.
If typical appendicitis signs and symptoms are detected, the doctor will diagnose appendicitis. If they are not, further tests will be ordered. Tests may include:
- Blood test - to check for infection.
- Urine test - this can identify a kidney or bladder infection. Researchers at the Proteomics Center at Children's Hospital in Boston, MA, demonstrated that a protein detectable in urine might serve as a biomarker for appendicitis.
- MRI, CT, or ultrasound scan - creates a 3D image of the appendix to check whether it is inflamed.
Sometimes the doctors will decide to surgically remove the appendix because it is too risky to wait for tests to confirm the diagnosis.
Treatments for appendicitis
Doctors may decide to treat the patient just with antibiotics. This is rare and the infection would need to be very mild. In most cases, an appendectomy will be performed - the appendix will be surgically removed.
Laparoscopy (keyhole surgery)
Surgical removal of the appendix is known as an appendectomy.
Laparoscopic surgery is also known as minimally invasive surgery (MIS), band aid surgery, or keyhole surgery.
The surgeon inserts a very thin tube (laparoscope), which has a tiny video camera and a light, into the abdomen through a cannula (a hollow instrument).
The surgeon can view the insides of the abdomen with magnification on a monitor.
Tiny instruments respond to the movements of the surgeon's hands, and the appendix is removed through small abdominal incisions.
Thanks to the precision of the operation, minimal loss of blood, and the small size of the incisions, the patient recovers much faster and with less scarring, compared with traditional open surgery. In most cases, it is no longer necessary to open the patient up with a large incision.
However, a report in the Journal of the American College of Surgeons suggests that a traditional, open appendectomy may be preferable to a less-invasive laparoscopic appendectomy for many patients with acute appendicitis. Laparoscopic surgery may increase costs and raise the risk of complications in the majority of appendectomy patients.
If the appendix has ruptured and infection has spread, or if there is an abscess, a larger incision will be made so that the area inside the abdominal cavity can be cleaned.
Traditional appendectomy is also used if the patient has tumors in the digestive system, if a woman is in her third trimester of pregnancy, or if the patient has had many abdominal surgeries before.
After the operation, the patient will be given antibiotics intravenously.
If the patient has had symptoms for at least 5 days, the doctor may recommend a course of antibiotics to shrink the appendix and clear up the surrounding infection, and perform surgery later.
Researchers from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, United Kingdom, explain that surgery does not have to be the first line of treatment for acute uncomplicated appendicitis - antibiotics may be a safe and viable alternative. They published their study in the BMJ in 2012.
However, scientists from Assistance Publique-Hôpitaux de Paris and Université Paris XI, Paris, France, disagreed. They wrote in their study, published in The Lancet, that surgery for appendicitis is much more effective than antibiotics.
If there is an abscess, the doctor may drain it first and operate at a later date.
Possible complications of appendicitis
The following are possible complications caused by appendicitis:
If the appendix ruptures and releases the infection into the abdomen, the patient may develop peritonitis, which is an infection and inflammation of the peritoneum. The peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs.
Peritonitis may cause the bowels to shut down - bowel movements will stop, and the bowel will become blocked. The patient will develop a fever and could go into shock. Peritonitis requires urgent treatment.
If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. If the abscess is not treated, it can cause peritonitis. Sometimes, abscesses are treated with antibiotics. Often, they are surgically drained with the aid of a tube which is placed into the abdomen.
Countries with lower incidences of appendicitis also tend to have more fiber in their diets. It would, therefore, be logical to assume that a high fiber diet may help reduce the chances of developing appendicitis.
One theory is that with a high-fiber diet, the resulting softer stools are less likely to get trapped in the appendix.