Appendicitis is a condition where the appendix becomes swollen, inflamed, and filled with pus. The appendix is a small finger-shaped pouch on the right side of the abdomen, connected to the colon.
The exact role of the appendix is not clear. It may be an area that hosts friendly bacteria, which help digestion and fight infection.
It may also be related to the immune system and influence the body's ability to fight off infection.
Appendicitis probably happens because either a stomach infection moves to the appendix or a hard piece of stool becomes trapped in the appendix, causing infection
Appendicitis can occur at any age, most commonly ranging from older children to adults in their 30s. It most commonly occurs in the second decade of life. More than 250,000 appendectomies (removal of the appendix) are performed in the United States each year.
Fast facts on appendicitis
- 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.
The first sign of appendicitis is often pain across the abdominal area.
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
- painful coughing or sneezing
- 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 a urinary tract infection. Even so, they all require urgent medical attention.
Around half of all patients with appendicitis do not have typical symptoms, and this can make it hard to diagnose. For example, the pain is not always located in the right lower quadrant of the abdomen.
Additionally, other conditions may have similar symptoms, such as:
Not everybody's appendix is in the same place. Sometimes it is located behind the colon, behind the liver, or in the pelvis.
A doctor will examine the patient and ask some questions related to their symptoms. They may apply pressure to the area to see if it worsens the pain.
If the doctor detects typical signs and symptoms, they will diagnose appendicitis. If not, further tests will be ordered.
Tests may include:
- blood tests, to check for infection
- an MRI, CT, or ultrasound scan, to see if the appendix is inflamed
- urine tests, to identify a kidney or bladder infection
Researchers at the Proteomics Center at Children's Hospital in Boston, MA, have demonstrated that a protein detectable in urine could be useful as a biomarker for appendicitis.
Sometimes, a doctor will decide to surgically remove the appendix because it is too risky to wait for tests to confirm the diagnosis.
If the infection is mild, antibiotics are sometimes used to treat appendicitis, but this is rare.
In most cases, a surgeon will remove the appendix. Often, this is done through keyhole surgery, or laparoscopy.
Laparoscopic, keyhole, or minimally invasive surgery (MIS) involves the following steps:
- The surgeon inserts a very thin tube, or laparoscope, which has a tiny video camera and light, into the abdomen, through a hollow instrument known as a cannula.
- The surgeon can view the inside of the abdomen, magnified, on a monitor.
- Tiny instruments respond to the movements of the surgeon's hands, and the appendix is removed through small abdominal incisions.
This is a precise operation, and there is minimal loss of blood and a small incision. As a result, recovery time is faster than with open surgery, and there is less scarring.
In some cases, a larger incision will be made, so that the area inside the abdominal cavity can be cleaned.
This will happen if:
- the appendix has ruptured, and infection has spread
- the appendix has caused an abscess
- the patient has tumors in the digestive system
- the patient is a woman in her third trimester of pregnancy
- the patient has had many abdominal surgeries before
After the operation, the patient will be given antibiotics intravenously.
If symptoms have lasted at least 5 days, the doctor may recommend a course of antibiotics to shrink the appendix and clear up the surrounding infection. They may perform surgery later.
If there is an abscess, the doctor may drain it first and operate at a later date.
Some scientists believe that antibiotics may be a safe and effective alternative for acute, uncomplicated appendicitis.
Others disagree. A study published in the Lancet argues that surgery for appendicitis is more effective.
In the case of keyhole surgery, the patient can usually go home after 24 hours. For the first few days, there may be some constipation and some pain and bruising. There my also be pain at the tip of the shoulder, because of gas that is pumped into the abdomen during the procedure.
Over-the-counter (OTC) painkillers may help with pain.
If open surgery is needed, or if the person has peritonitis or another complication, they may have to stay in the hospital for up to a week.
It usually takes around 2 weeks to return to normal activities, but the person may need to wait for 4 to 6 weeks to do more strenuous activity.
The doctor will advise about how much activity is suitable at each stage.
If there are signs of infection, it is important to contact the doctor.
- worsening pain and swelling
- repeated vomiting
- high temperature
- the site of the operation is hot to touch, or there is pus or other discharge
Countries with lower incidences of appendicitis also tend to have more fiber in their diets.
It may be that a high-fiber diet helps reduce the chances of developing appendicitis by creating softer stools are less likely to get trapped in the appendix.
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.
The complications of appendictis can be life-threatening. It is important to seek medical help for anyone who may have appendicitis.