Illustration

What is acute appendicitis?

Acute appendicitis is caused by inflammation of the appendix. The appendix is a small, fingerlike pouch, about ¼” wide and 2-3 inches long, that comes off the cecum, which is the part of the large bowel where the large and small intestines join. It usually lies in the lower right side of the abdomen. It serves no known function but can become swollen and inflamed, causing pain and tenderness.

It is important to get treatment for appendicitis before the wall of the appendix breaks down because of progressive inflammation and infection. In advanced stages of inflammation when the wall of the appendix begins to break down, it is sometimes called “gangrenous appendicitis”. When this happens, you could develop an abscess or spread of this infection into the abdomen causing peritonitis, which is a dangerous infection of the lining of the belly. This is also sometimes called “perforated” or “ruptured” appendicitis. Because of the risk of this happening if appendicitis is untreated, the treatment of appendicitis is considered an emergency. Because of the unusual location of the appendix or other reasons, about 20% of patients with appendicitis are unaware of their symptoms until the inflammation in the appendix has progressed through the wall or “perforated” and early diagnosis is not possible.  

How does it occur?

In most cases inflammation of the appendix is caused by a blockage of the opening of the appendix by local swelling in reaction to infection in the digestive tract or a piece of hardened stool. Rarely it is caused by a tumor.  

What are the symptoms?

The symptoms are different from person to person. The classic or most common presentation is:

• right lower quadrant abdominal pain, usually starting near the bellybutton, then moving to the right lower side of the belly between the belly button and the hip
• symptoms progress over 12 to 24 hours, becoming more severe and pain more local in one spot
• progressive tenderness in the right lower abdomen, which may be noticed with coughing or trying to move about
• loss of appetite or nausea, with or without vomiting
• fever, usually not very high.
• high normal to mildly elevated white blood cell count

In some cases, the symptoms of appendicitis are not a clear-cut and appendicitis is more difficult to diagnose. Pain may not start in the mid abdomen or belly button region. Tenderness may not be prominent.

How is it diagnosed?

Sometimes it is difficult to diagnose appendicitis, especially in young children, the elderly, and pregnant women. Your health care provider will review your symptoms and examine you. In young women it can be hard to tell the difference between appendicitis and inflammation or infection involving the pelvic organs (fallopian tubes and ovaries). 

You may have the following tests:

• blood tests
• urine tests
• abdominal CT (computed tomography:  a form of special x-ray). This is now the most common diagnostic test for patients with possible acute appendicitis.
• ultrasound exam of your belly.

How is it treated?

The treatment of acute appendicitis, in which the diagnosis is made early, is to surgically remove the inflamed appendix. The operation is called appendectomy. The operation may be done using a small incision in the right lower abdomen (traditional appendectomy) or by use of laparoscopic instruments (laparoscopic appendectomy) in selected patients. If the appendicitis is uncomplicated, that is, not associated with an abscess or perforation, you may go home as soon as 24 to 48 hours after operation.

If the infection in the appendix has progressed through the wall and formed an abscess, which can be seen on CT, a different treatment may be used. The abscess may be drained and antibiotics given. The appendix may not be removed until later. In very advanced cases, in which the diagnosis is made late and infection has spread widely, treatment can be much more complicated and difficult..

Because health care providers cannot always be sure that the appendix is inflamed until they examine it during surgery, about 10% of appendixes are removed that are not inflamed. If you are operated on and your appendix is found to look normal, it will still be removed, while other possible causes of abdominal pain are looked for. It is appropriate for a surgeon to risk removal of a normal appendix so that he or she is sure to not miss a case of true appendicitis.

In many instances, evaluation by a health provider does not find evidence of appendicitis and you can go home. If your provider does not believe you have appendicitis, and sends you home without surgery, your provider will probably ask you to:

• Contact your health care provider if you have progressive symptoms (increased pain, tenderness, fever) in the next 12 to 48 hours. If so, you should return for re-evaluation.
• Take your temperature every 2 hours and keep a record. Bring it with you when you return to see your provider.
• Use no pain medicine. Taking pain medicine could make it difficult for you to know if the pain gets better or worse.
• Take no antibiotics.
• If you return for another exam, do not eat or drink anything on the day of your exam, in case you have to have surgery.

If your health care provider sends you home, call your provider promptly if any of the following occur:

• continued or worsening vomiting
• increased pain in the abdomen
• higher fever

How long do the effects last?

The usual stay in the hospital after an appendectomy is 1-3 days, depending on your age, other medical problems and physical condition, if you have uncomplicated appendicitis. If your appendix is gangrenous or ruptured, you may stay in the hospital 7 days or longer. You can live a normal life without an appendix.

How can I take care of myself after appendectomy?

The most important factor in your recovery after surgery is to follow the instructions of your health care provider. To feel better as soon as possible you should:

• Be out of bed and walk as much as you can comfortably. Rest in between.
• Get plenty of sleep.
• Eat your normal diet, as tolerated.
• Avoid constipation by using foods high in fiber and stool softeners. Use suppository or milk of magnesia in needed, with permission of your health care provider.
• Continue taking any prescribed medication until it is finished.
• Contact your provider if the following signs of wound infection appear:

• redness or warmth and increasing tenderness at the incision
• fever.

Can I help prevent appendicitis?

There is no sure way to prevent appendicitis. However, appendicitis may be less common in people who eat foods containing fiber and roughage such as raw vegetables and fruits.

If you think you might have appendicitis, call your health care provider right away and have him or her see you.