Appendicitis

In this article

Whats is appendicitis? What are the symptoms? What causes appendicitis? What complications can happen? How is to diagnosed? How is it treated? Surgery to remove the appendix (appendectomy) Draining an abscess before appendix surgery How is the recovery?

Whats is appendicitis?

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

What are the symptoms?

Signs and symptoms of appendicitis may include:

  • Sudden pain that begins on the right side of the lower abdomen
  • Sudden pain that begins around your navel and often shifts to your lower right abdomen
  • Pain that worsens if you cough, walk or make other jarring movements
  • Nausea and vomiting
  • Loss of appetite
  • Low-grade fever that starts after the onset of pain and may worsen as the illness progresses
  • Constipation or diarrhea
  • Abdominal bloating

The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

What causes appendicitis?

A blockage in the lumen of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. causing a severe inflammation called peritonitis.

What complications can happen?

A ruptured appendix

A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.

A collection of pus (Abscess)

If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two weeks, and you're given antibiotics to clear the infection. Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

Mass formation

A walled off collection of pus by abdominal structures such as bowel and fat (omentum). In this scenario, it is probably wise to treat with antibiotics to reduce the infection.

How is to diagnosed?

To help diagnose appendicitis, your surgeon will likely take a history of your signs and symptoms and examine your abdomen. Your surgeon’s expertise and experience plays a key role in the diagnosis of appendicitis. Physical exam to assess your pain. Your surgeon may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your surgeon also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your surgeon may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. Sometimes additional tests may help to clear out the doubts.

Tests and procedures used to diagnose appendicitis include:

  • Blood test: This allows your doctor to check for a high white blood cell count, which may indicate an infection.
  • Urine test: Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.
  • Imaging tests: Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.

How is it treated?

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity. Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

How is the recovery?

Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal:

Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery.

Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.

Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor.

Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks.

Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to.

Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports.