Appendicitis is a painful inflammation or swelling of the appendix. The appendix is a finger-shaped pouch about 5-10cm (2-4 inches) long that extends from the large intestine (where stools are formed) on the lower right side of your abdomen.
It is not clear if the appendix has an important role in the body in older children and adults. In young children it may have an immune function. One study suggests that the appendix may have some role in gut immunity, but nothing is definite. One thing we do know is that we can live without it, without apparent consequences.
Appendicitis is the most common paediatric condition requiring emergency abdominal surgery. It can be a life-threatening condition that requires immediate medical care, which makes it a medical emergency.
Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30.
Causes of Appendicitis
There is no clear cause of appendicitis, though it is thought one possible cause may be when the appendix becomes blocked, often by stool, a foreign body, or cancer. Also, bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall.
Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis.
Appendicitis is not transmittable from person to person.
What are the Symptoms of Appendicitis?
The classic symptoms of appendicitis include:
Sudden pain that begins on the right side of the lower abdomen
Sudden pain that begins around your navel and often shifts to your lower right abdomen
Pain that worsens if you cough, walk or make other jarring movements
Nausea and/or vomiting soon after abdominal pain begins
Loss of appetite
Low-grade fever that may worsen as the illness progresses
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
Constipation or diarrhoea with gas
The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.
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.
If left untreated or immediately attended to, appendicitis can cause serious complications, such as:
A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two weeks, and you're given antibiotics to clear the infection.
Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.
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
Blood test to see if your body is fighting infection
CT scans and/or ultrasound
Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis. Antibiotics almost always are begun prior to surgery and as soon as appendicitis is suspected.
There is a small group of patients in whom the inflammation and infection of appendicitis remain mild and localized to a small area. The body is able not only to contain the inflammation and infection but to resolve them as well. These patients usually are not very ill and improve during several days of observation. This type of appendicitis is referred to as "confined appendicitis" and may be treated with antibiotics alone. The appendix may or may not be removed at a later time. There is still some controversy, however, about leaving the healed appendix in place since appendicitis can recur.
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 as a result of being ruptured, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix.
Within 12 hours of surgery you may get up and move around. You can usually return to normal activities in two to three weeks. But 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:
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
However, there is some research showing that treatment of acute appendicitis with antibiotics may eliminate the need for surgery in certain cases.
Lifestyle and home remedies
Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal:
Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery.
Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.
Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor.
Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks.
Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to.
Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to six weeks to resume strenuous activity, such as gym classes or sports.
Stump appendicitis is a very rare condition where a small amount of remaining appendix tissue from a previous appendectomy becomes inflamed. Less than 1% of patients who had appendectomy developed stump appendicitis, in one retrospective study. Symptoms are similar to the original appendicitis, with right lower quadrant pain being the most common symptom and it is treated similarly to appendicitis.
Can Appendicitis Be Prevented?
There is no way of predicting when appendicitis will occur or prevent it from occurring.
There are no proven risk factors for appendicitis. It has been suggested that potential risk factors may include a diet low in fibre and high in sugar, family history, and infection.
However, eating fresh fruits and vegetables may be helpful.