Everything you need to know about appendicitis

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The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states that the most common symptom of appendicitis is abdominal pain that begins near the belly button. It will then progress lower and to the right.

The pain may:

• worsen with movement, coughing, sneezing, or deep breaths
• be severe
• worsen within hours

Other symptoms include:

• abdominal swelling
• fever
• appetite loss
• nausea
• vomiting

Children with appendicitis may not experience typical symptoms.

A person may also experience a frequent and urgent need to urinate, although this is extremely uncommon.

Anyone who experiences progressively worsening pain in the abdomen should seek medical attention. Other conditions, such as a urinary tract infection, may have similar symptoms. Even so, these conditions all require urgent medical attention.

Acute appendicitis is the more common type of appendicitis. The onset typically occurs over 24 hours.

Appendicitis is a medical emergency and needs to be evaluated quickly. The appendix can rupture during appendicitis, and the risk of this rises 48–72 hours after symptoms begin.

Chronic appendicitis is a less common form of appendicitis that lasts longer than acute appendicitis.

A 2015 article says that chronic appendicitis is a less severe, continuous pain that lasts for longer than the usual 1- or 2-day period. The pain can last for weeks, months, or years.

Unlike acute appendicitis, healthcare professionals do not consider chronic appendicitis a medical emergency.

A CT scan can help diagnose chronic appendicitis, and treatment involves removing the appendix.

Learn more about chronic appendicitis here.

A doctor will examine the person and ask some questions about their symptoms. The doctor may apply pressure to the lower abdominal area to see whether pressure worsens the pain.

If the doctor detects the typical signs and symptoms of appendicitis, they will diagnose it. If not, they will order further tests.

Tests may include:

• blood tests to check for infection
• an MRI, CT, or ultrasound scan to see whether the appendix is inflamed
• urine tests to identify a kidney or bladder infection

The NIDDK states that a doctor will prescribe antibiotics for anyone with appendicitis.

In some cases, this is enough to treat appendicitis, and surgery will not be necessary. In most cases, however, a surgeon must remove the appendix.

Surgical options for appendicitis include:

• Laparoscopy: This is a precise procedure in which there is minimal loss of blood and only a small incision. As a result, recovery time is faster than with open surgery, and there is less scarring. Laparoscopic, keyhole, or minimally invasive surgery (MIS) involves the following steps:
  1. 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.
  2. The surgeon views the inside of the abdomen, magnified, on a monitor.
  3. Tiny instruments respond to the movements of the surgeon’s hands, and the appendix is removed through small abdominal incisions.
• Open surgery: In rare 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 person in their third trimester of pregnancy.
  • The patient has had many abdominal surgeries before.

After open surgery, a doctor will give the person antibiotics intravenously.

In the case of keyhole surgery, the person can usually go home after 24 hours. For the first few days, the person may experience some constipation, pain, and bruising.

There may also be pain at the tip of the shoulder. During the surgery, the surgeon pumps gas into the abdomen. This can lead to stimulation of the phrenic nerve at the diaphragm, which causes referred pain. Referred pain occurs at a location other than where the real source of pain exists.

Over-the-counter (OTC) pain relievers may help with postsurgical 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.

After a laparoscopic surgery, a person should limit physical activity for 3–5 days. They should avoid physical activity for 10–14 days after a laparotomy.

The doctor will advise about how much activity is suitable at each stage of recovery.

If there are signs of infection, it is important to contact the doctor.

Signs of infection include:

• worsening pain and swelling
• repeated vomiting
• high temperature
• the site of the operation is hot to touch
• the site of the operation has pus or other discharge

There is no proven way to prevent appendicitis.

Knowing the signs and symptoms and when to contact a doctor can be helpful.

Appendicitis is the most common non-pregnancy-related emergency requiring surgery during pregnancy.

Diagnosis of appendicitis can be difficult during pregnancy because the common symptoms of appendicitis are not always present. In addition, the symptoms can be similar to those experienced from pregnancy itself.

Symptoms include:

• pain
• nausea
• appetite loss
• vomiting
• fever

Atypical symptoms include:

• heartburn
• gas
• constipation
• diarrhea

Physical examination may be difficult depending on how far the person has progressed in their pregnancy. Biochemical markers for appendicitis used in laboratory work may be unreliable during pregnancy. Imaging may be used for diagnosis.

As in people who are not pregnant, the cause of appendicitis during pregnancy is usually a blockage that produces inflammation and infection. Surgery to remove the appendix is often the recommended course of treatment.

The following are possible complications:

Peritonitis

If the appendix ruptures and releases the infection into the abdomen, a person may develop peritonitis. Peritonitis is 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 bowel movements to stop and the bowel to become blocked. The person will develop a fever and could go into shock. Peritonitis requires urgent treatment.

Abscess

If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. Without treatment, this can cause peritonitis. Sometimes, antibiotics can treat an abscess. Often, a doctor will surgically drain the abscess with the aid of a tube, which is placed into the abdomen.

Other complications

Other complications include:

• ileus, which is when the bowel does not work correctly
• a fistula, which is an abnormal connection between the stomach and the intestine
• small bowel obstruction
• infection at the surgical site

The complications of appendicitis can be life threatening. Anyone who may have appendicitis should seek medical help immediately.

If any of the symptoms of appendicitis are present, call a doctor or visit an emergency department. Appendicitis is a serious condition that requires immediate treatment.

Appendicitis is when the appendix, a small, tube-shaped organ attached to the large intestine, becomes blocked and infected. It is a serious medical condition that requires a quick evaluation.

Appendicitis is generally acute, with symptoms coming on over the course of a day and becoming severe rapidly. Chronic appendicitis can also occur, although it is rare. In chronic cases, symptoms are less severe and can last for days, weeks, or even months.

Treatment for appendicitis will depend on how severe the case is. A person may need to undergo surgery, which can be performed laparoscopically or though an open incision. A person may need to take antibiotics to treat the infection before surgery or in mild cases.