Appendicitis
Appendicitis means inflammation of the appendix. The appendix is a short, narrow pouch of intestine (bowel), which is closed at one end. The appendix arises from the caecum, which is the first part of the large intestine.
In appendicitis, the appendix becomes inflamed, swollen and infected. The appendix may form an abscess (a collection of pus) or even burst, spreading the infection around the abdominal cavity, causing peritonitis (a very serious condition involving inflammation of the membrane that lines the inner wall of the abdomen and the internal organs).
Appendicitis affects mainly older children and young adults (most commonly those aged 10-30 years), although it can occur at any age.
Causes
It’s not always clear what has caused appendicitis. Sometimes it follows a blockage of the opening of the appendix or a gastrointestinal infection.
Appendicitis symptoms
Most people with appendicitis will experience cramping or aching abdominal pain. This usually starts in the middle of the abdomen, around the umbilicus (navel, or 'belly button'). In most cases, the pain gradually worsens, becomes constant, and moves down to the lower right side of the abdomen. Often the pain becomes worse with movement — walking, moving in bed, or even coughing.
Other symptoms include:
- loss of appetite;
- nausea;
- vomiting;
- fever; and
- constipation or diarrhoea.
Some people do not experience these typical appendicitis symptoms. Pregnant women and young children are more likely to report pain in different areas of the abdomen.
Diagnosis
Your doctor will ask about your symptoms and do a physical examination, including an abdominal examination.
People with appendicitis usually experience tenderness and complain of pain when pressure is applied to the lower right side of the abdomen. Doctors will also look for 'rebound tenderness' — sharp pain in the lower right area of the abdomen that occurs when pressure is applied to the area and then quickly released.
Ultrasound, abdominal X-rays or computerised tomography (CT), as well as blood tests and urine tests, can be useful in determining whether or not the diagnosis is appendicitis.
Treatment for appendicitis
Appendicectomy
Treatment usually consists of an urgent surgical operation (appendicectomy, or appendectomy) to remove the appendix. The appendix does not seem to have any useful purpose in humans, so if it needs to be removed it is not missed.
The appendix can either be removed in the traditional way, with a single incision (cut) about 5-7 cm long, or via laparoscopic surgery (sometimes referred to as keyhole surgery).
Laparoscopic surgery involves several small incisions (1-2 cm long) being made in the abdomen, through which specialised instruments and a special tiny video camera are inserted. The appendix can then be removed under video surveillance. With this type of surgery there is less post-operative pain, less scarring and a faster recovery time than with open surgery, but it is not suitable in all cases.
Antibiotics may also be given to treat the infected appendix.
Non-surgical treatment
Non-surgical treatment may be a possibility in some circumstances (for example, if surgery is not available or the person is too unwell to undergo an operation). Non-surgical treatment consists of antibiotics to treat infection and a liquid or soft diet until the infection subsides.
Appendicitis is a medical emergency that requires immediate care. Prompt treatment is usually followed by a rapid recovery. However, if the diagnosis is delayed, complications can occur and appendicitis may be life-threatening.
Last Reviewed: 12 December 2012
- 1. Royal Children’s Hospital Melbourne. Kids Health Info: Appendicitis 1 – infected appendix (updated Oct 2010). http://www.rch.org.au/kidsinfo/fact_sheets/Appendicitis_1_infected_appendix/# (accessed Dec 2012).
2. Royal Children’s Hospital Melbourne. Kids Health Info: Appendicitis 2 – removing the appendix (updated Oct 2010). http://www.rch.org.au/kidsinfo/fact_sheets/Appendicitis_2_Removing_the_appendix/ (accessed Dec 2012).
3. National Digestive Diseases Information Clearinghouse. Appendicitis (updated 16 Feb 2012). http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/ (accessed Dec 2012).
4. MayoClinic.com. Appendicitis (updated 13 Aug 2011). http://www.mayoclinic.com/health/appendicitis/DS00274 (accessed Dec 2012).
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