Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. One study suggests that the appendix may have some role in gut immunity, but nothing is definite. One thing we do know: We can live without it, without apparent consequences.
Appendicitis is a medical emergency that almost always requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.
Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix can perforate or explode and cause peritonitis. For this reason, almost all cases of appendicitis are treated as emergencies, requiring surgery.
In the U.S., one in 20 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30.
What Causes Appendicitis?
Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also occur from infection, since the appendix can swell in response to any infection in the body.
What Are the Symptoms of Appendicitis?
The classic symptoms of appendicitis include:
- Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign.
- Loss of appetite
- Nausea and/or vomiting soon after abdominal pain begins
- Abdominal swelling
- Fever of 99-102 degrees Fahrenheit
- Inability to pass gas
Almost half the time, other symptoms of appendicitis appear, including:
- Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum
- Painful urination and difficulty passing urine
- Vomiting that precedes the abdominal pain
- Severe cramps
- Constipation or diarrhea with gas
If you have any of the mentioned symptoms, seek medical attention immediately, because timely diagnosis and treatment is very important. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture.
How Is Appendicitis Diagnosed?
Diagnosing appendicitis can be tricky. Symptoms of appendicitis are frequently vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn's disease, gastritis, intestinal infection, and ovary problems.
The following tests are usually used to help make the diagnosis:
- Abdominal exam to detect inflammation
- Urine test to rule out a urinary tract infection
- Rectal exam
- Blood test to see if your body is fighting infection
- CT scans and/or ultrasound
How Is Appendicitis Treated?
Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis.
Generally, if appendicitis is suspected, doctors tend to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix. However, there is some research showing that treatment of acute appendicitis with antibiotics may eliminate the need for surgery in certain cases.
Appendectomy: What to Expect
Antibiotics are given before an appendectomy to fight possible peritonitis. General anesthesia is usually given, and the appendix is removed through a 4-inch incision or by laparoscopy. If you have peritonitis, the abdomen is also irrigated and drained of pus.
Within 12 hours of surgery you may get up and move around. You can usually return to normal activities in two to three weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), the incision is smaller and recovery is faster.
After an appendectomy, call your doctor if you have:
- Uncontrolled vomiting
- Increased pain in your abdomen
- Dizziness/feelings of faintness
- Blood in your vomit or urine
- Increased pain and redness in your incision
- Pus in the wound
Can Appendicitis Be Prevented?
There is no way to prevent appendicitis. However, appendicitis may be less common in people who eat foods high in fiber, such as fresh fruits and vegetables.