Symptoms of appendicitis may require emergency medical attention. Without immediate care, the appendix can burst. A burst appendix releases bacteria and pus, which can cause severe complications.
The appendix is a small finger-shaped pouch on the right side of the abdomen. The exact role of the appendix is not clear. Appendicitis is a condition where the appendix becomes swollen, inflamed, and filled with pus.
When a doctor suspects appendicitis, a surgeon may need to remove the appendix to prevent a burst appendix.
Keep reading to learn more about the symptoms and causes of a burst appendix. We also discuss the possible treatments for a burst appendix.
The accumulation of bacteria in the appendix causes the immune system to activate, and the process of inflammation begins.
Appendicitis is the most common cause of acute abdominal pain that needs surgery in the United States. Over 5% of the population develops appendicitis during their lifetime, with more than 250,000 cases occurring every year.
Appendicitis most commonly occurs during a person’s teenage years or when they are in their 20s. However, appendicitis can happen at any age.
Researchers suggest that the risk of appendix rupture is about 2% after 36 hours from the beginning of symptoms. The risk increases by about 5% every 12 hours thereafter.
The first symptom of appendicitis is usually severe and sudden pain in the abdomen. It often begins near the belly button and then moves lower and to the right.
The pain may become more intense within the next few hours and become worse by moving, coughing, sneezing, or taking deep breaths.
According to the National Institutes of Health (NIH), other signs and symptoms of appendicitis may include:
However, 55% of people do not present with typical appendicitis symptoms.
Younger children are at a higher risk of a burst appendix, as they may not be able to talk clearly about their symptoms.
Appendicitis can have more than one cause, and in many cases, doctors may not know the exact reason for appendicitis. The condition typically occurs when part of the appendix becomes obstructed, or blocked.
Obstruction can occur from:
- hardened stool
- enlarged lymphatic tissue
- traumatic injury to the abdomen
If there is an obstruction in the appendix, bacteria will get trapped and begin to multiply, causing an infection. This can lead to the formation of pus and swelling, which can cause painful pressure in the abdomen.
If not treated promptly and appropriately, the pressure will continue to build, causing the appendix to swell. The swelling may lead to part of the appendix dying due to a lack of blood supply.
With significant inflammation, pressure, and cell death, the appendix may burst. When the appendix bursts, the bacteria and pus leak into the abdomen.
When this spillage occurs, it can cause peritonitis, which can be fatal without rapid treatment.
Diagnosing appendicitis accurately and efficiently can reduce complications. However, with more than half of all people with appendicitis not presenting with typical symptoms, doctors can find it difficult to make a diagnosis.
To diagnose appendicitis, doctors will review the symptoms the individual is experiencing and their medical history to potentially rule out other health issues.
The doctor will then perform a physical exam to find out more about the person’s stomach pain. During the physical exam, the doctor may look for:
- tenderness or pain in the right lower abdomen
- muscle rigidity
- pain around the belly button area
To rule out other possibilities, doctors may also request:
Doctors may consider intravenous antibiotics as first-line therapy for some people. Antibiotic treatment may be sufficient for certain mild cases.
The standard treatment for appendicitis is an appendectomy, which is surgery to remove the inflamed appendix before it bursts.
If a doctor suspects that a person has a burst appendix, they may recommend immediate removal without conducting diagnostic testing.
Removing the appendix as soon as possible is the best prevention for a burst appendix. Early treatment is important to reduce the risk of complications, which can lead to death.
Surgeons can use one of two methods to remove the appendix:
During laparoscopic surgery, the surgeon will make several small incisions and use special surgical tools to remove the appendix.
With laparotomy surgery, instead of several small incisions, the surgeon will make a single incision in the lower right area of the abdomen to remove the appendix.
This may be necessary in the case of a burst appendix. The single incision allows the surgeon to clean the abdomen of pus and bacteria to prevent infection.
Recovery from an appendectomy is usually quick. Most people will completely recover from appendicitis. Doctors typically will not recommend changing diet, exercise, or lifestyle.
To limit complications of appendicitis, the surgeon will remove the appendix and clean the inside of the abdomen to prevent infection.
Without proper treatment, a person can develop peritonitis, which is an inflammation of the peritoneum, or lining of the abdomen. Peritonitis can cause death.
Appendectomy is usually a safe procedure. An older study suggests that the mortality rate for unruptured appendicitis is 0.8 per 1,000 people. After the appendix bursts, the mortality rate for an appendectomy is 5.1 per 1,000 people.
Delaying surgery may increase the risk of complications. However, complications after surgery that takes place quickly are usually rare.
Although doctors have not found ways to prevent appendicitis, people should speak to a doctor as soon as possible if they suspect they have appendicitis.
Prompt medical attention for acute appendicitis, and early surgery, can prevent the appendix from bursting.
In some situations, the surgeon may find an appendix that seems normal in a person with appendicitis. The doctor will likely still remove the appendix. Removing an appendix that appears normal eliminates the possibility of appendicitis, and it bursting in the future.
People with symptoms of appendicitis need to see a doctor as soon as possible.
Unexplained nausea, vomiting, and pain on the right side of the body that worsens over time require medical attention.
Before the introduction of surgical treatment, more than 50% of people with appendicitis died. With surgical treatment, doctors report that appendectomy reduced the mortality rate to 15%. Today, about 1%–3% of people may die from appendicitis.
People with symptoms of lower right side abdominal pain, nausea, and fever should consult a doctor immediately.
A doctor will perform a physical examination and may order blood tests and imaging to confirm the diagnosis of appendicitis.
The usual treatment for appendicitis, with or without a burst appendix, is surgery. The surgeon will remove the appendix to prevent it from bursting and clean up any debris in the abdomen.
With inappropriate treatment, people may develop complications from an appendectomy, such as abscess and infections, which can cause severe complications.