Appendicitis

Also known as peritonitis

Appendicitis means inflammation of the appendix - a small, finger-like pouch that comes out of the gut wall at the start of the large intestine.

Appendicitis can be life threatening – if you or someone else is suffering from severe symptoms, including intense tummy pain you may be at risk of a burst (or perforated) appendix, which requires urgent medical attention.

Causes

In most cases the reason why the appendix becomes inflamed is not known. It may be due to a blockage in the appendix. This may be due to faecal matter (poo) or indigestible food getting stuck there. This provides a rich breeding ground for bacteria to thrive, causing the appendix to become infected, swollen and full of pus.undefined

Symptoms

The main symptom of appendicitis is tummy pain. As the inflammation gets worse, the pain increases and becomes very severe. Other symptoms may include:

  • fever
  • nausea
  • vomiting
  • diarrhoea.

At first, you may notice abdominal pain as a dull pain around the tummy button (naval).

As the inflammation worsens, the pain becomes sharper and may move down to the lower right-hand side of the abdomen, above where the appendix is normally located.

The pain rapidly worsens and over a 6 to 24 hour period can become severe.

The area around the site of the pain becomes very tender. If you gently pushed two fingers into your abdomen it would be very painful; the pain on releasing the fingers can be even worse.

Not all cases of appendicitis follow this 'classic' course. In some cases, the pain is felt higher in the tummy (particularly if you are pregnant) or closer to the back passage (anus). In other cases the pain is quite mild and does not become severe until the appendix bursts.

Complications

If your appendix bursts severe pain can spread to the whole abdomen. Your tummy will feel hard and tight, and you will not be able to push your fingers into it at all. Coughing and any movement, particularly of the legs at the hips, will be painful. The pain is caused by the entire lining of the abdomen (the peritoneum) becoming infected and inflamed. This is known as peritonitis.

Diagnosis

If you have symptoms of appendicitis, your doctor may be able to diagnose what is wrong easily, based on your description of symptoms and a physical examination. Other times, this is difficult to do because there are many possible causes of abdominal pain and no simple test to be sure if it is appendicitis.

Therefore, to make a diagnosis, doctors use a range of tools which include:

  • Asking questions like" When did you first have this pain? Where does it hurt?"
  • Performing a physical examination to look for tenderness.
  • Blood tests looking at the white blood cell count for signs of infection.
  • Urine test to rule out urine infection, and women are usually offered pregnancy tests.
  • Sometimes an ultrasound may be used to help identify the cause of abdominal pain.

Treatment

Treatment is normally an operation to remove the inflamed appendix before it bursts. This procedure is called an appendectomy.

Laparscopic appendectomy: In straightforward, non-complicated situations, surgeons will often perform the appendectomy through a laparoscopic technique, using very small holes and a video camera to remove the appendix without the need for a larger cut.

Open appendectomy: In more difficult cases, an “open” approach is performed, in which a slightly larger incision (cut) is made on the abdomen to remove the appendix. This surgery is generally combined with the use of antibiotics. How much and how often you have to take the antibiotics may vary, depending on the severity of your condition.

If the appendix has already ruptured, you will be admitted to hospital for close observation and given intravenous antibiotics. You may be given an “open” appendectomy to wash out the fluid contents that have leaked from the ruptured appendix.

Self-care

Once you have been discharged from hospital you need to:

Care for your incision site(s)

  • Keep the site clean, washing daily with gentle soap and water.
  • Your doctor will tell you when you may remove the dressing covering the incision site, this will normally be 48 hours after the operation
  • In some cases, small thin strips may be seen covering your incision once you have removed the bandage – these are longer-lasting bandages, and can be left in place until they begin to fall off on their own (generally in 1-2 weeks).

When to see your doctor again

  • You will usually have a follow-up visit 10-14 days after your surgery.
  • In the meantime, call your doctor immediately if any of the following symptoms develop:
    • fever
    • new redness spreading outward from your incision site
    • pus or other drainage from your incision
    • sudden onset of severe nausea/vomiting
    • new and worsening severe abdominal pain.

Activity limitations

  • Do not perform heavy lifting or strenuous activity until you have been seen at your checkup appointment
  • Ask your surgeon about when is safe to return to your regular job. This will depend on the type of work you do and whether your appendectomy was laparoscopic or open (see treatment above)

Pain control

  • In most cases, pain felt after surgery should be minimal after the first few days.
  • Your surgeon will provide you with a prescription for pain medication. Use this only if you are having pain that you would consider moderate to severe. 
Credits: Written by surgical doctor. Edited by Health Navigator. Reviewed By: Editorial team