What Is Appendicitis?
Appendicitis refers to inflammation of the appendix, a small finger-like structure in the lower right corner of the belly. Appendicitis is extremely common, occurring in about five to 10 percent of people at some point in their lifetime [1-3]. While it can occur at any age, the most commonly affected groups are adolescents and young adults.
Severe abdominal pain and nausea are the most common symptoms, often accompanied by vomiting and possible fever.
Untreated appendicitis can be life-threatening, therefore, it is usually considered a surgical emergency and remains one of the most common reasons for urgent abdominal surgery. In some hospitals, low-risk cases of appendicitis are managed with antibiotics alone rather than surgery, though surgery remains the gold standard treatment in much of the world.
Seek medical care at an ER immediately as this is an emergency.
Symptoms of appendicitis usually begin suddenly and worsen significantly over a few hours. These typically include the following [1-5].
- Severe abdominal pain: This is the single most common symptom of appendicitis. It classically begins in the middle of the abdomen around the belly button, then migrates to the lower right corner near the appendix itself. However, the exact pattern of pain varies based on differences in anatomy from one person to the next. Usually, the pain is mild at first but becomes severe over several hours, particularly with movement.
- Nausea and vomiting: These are both common, as is a loss of appetite.
- Fever: This is typically low-grade but can be very high if the appendix ruptures and bacteria spread throughout the abdomen (peritonitis).
The appendix comes off of the large intestine, or bowel, in the lower right portion of the abdomen. Its purpose is still not entirely clear, theories have suggested that it acts as a reservoir of bacteria that can serve to replenish the intestines when their bacterial balance (or "gut flora") is offset by infection or antibiotics.
Broadly speaking, appendicitis is caused by a blockage in the appendix . This obstructs the normal pathway for bacteria and stool to move between the appendix and the rest of the intestines, triggering bacterial overgrowth and inflammation within the appendix . Various things can cause this sort of blockage, though the specific cause in a given person is often unknown. Possibilities include the following:
- Feces: This is most often the cause of the blockage. Feces should normally be found in the bowel and appendix but happen to have gotten stuck.
- Tissue inflammation: This can be due to infection, abdominal trauma or autoimmune disease (where the body attacks itself).
- Less common causes: This includes tumors, intestinal parasites, and excess mucus production [2,5].
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Treatment Options and Prevention for Appendicitis
Treatment of acute appendicitis generally consists of some combination of pain control, surgery, and antibiotics.
Surgery (general considerations)
Classically, appendicitis has been considered a surgical emergency. Appendectomy is the surgical removal of the appendix. It is generally considered the gold standard treatment for acute appendicitis [1-6].
- Urgent appendectomy: In most cases, surgery should be performed as soon as possible after diagnosis to decrease the risk of a burst appendix. Even if the appendix has already burst, urgent surgery is preferred when possible [5,6].
- Antibiotics followed by appendectomy: Sometimes if the appendix has burst or a bacterial pocket has formed, a person may be too sick to safely undergo surgery [1-6]. This usually means the person needs several weeks of antibiotics and possibly drainage of the infected site while waiting for the infection to "cool down" so the appendix can be safely removed.
Surgery (open vs. laparoscopic)
While appendectomy was traditionally performed with an open abdominal surgery known as a laparotomy, many centers now prefer a less invasive technique called laparoscopy in which cameras and tools are inserted through multiple smaller holes. Laparoscopy often allows for faster recovery while open surgery is preferred for complicated cases such as a ruptured appendix . The decision is largely based on the surgical team's experience and comfort with one technique or the other.
Antibiotics have long been used to prevent infections following an appendectomy and in the treatment of a burst appendix (where gut bacteria spread throughout the belly) [1-6]. More recently, research has focused on the use of antibiotics alone as an alternative to surgery. Current professional guidelines in the United States still consider appendectomy the preferred treatment method [1,2]. This is largely due to the limited body of evidence supporting non-operative antibiotic treatment. Furthermore, evidence suggests that many people treated with antibiotics alone will have another bout of appendicitis within the following year [3-6]. Non-operative treatment of mild, uncomplicated appendicitis is becoming more common, particularly in Europe.
The only way to prevent appendicitis is surgical removal of the appendix. However, the risk of elective surgery in healthy individuals is believed to outweigh the benefits of potentially preventing future appendicitis. That said, elective appendectomy is occasionally performed in people already undergoing abdominal surgery for other reasons and is a highly debated issue among surgeons .
Because blockages in the intestine often contribute to appendicitis, it has been suggested that diets high in fiber or rich in fruits in vegetables could help prevent appendicitis [1,2].
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When to Seek Further Consultation for Appendicitis
Whether with surgery or antibiotics, appendicitis needs to be treated promptly. If you or someone you know has symptoms concerning for appendicitis, please stop reading and seek medical care immediately. If untreated, the appendix can rupture spilling bacteria and other bowel contents into the abdominal cavity. This is extremely dangerous, far harder to treat than a contained appendicitis, and often deadly [1-6].
For those with a history of appendicitis, long-term treatment is rarely needed. In most cases, surgical removal of the appendix is curative. Most people with appendicitis that has not resulted in a rupture can go home within a few days of surgery, or sometimes even the same day . Those who have suffered a perforated appendix will usually require a longer hospital stay, possibly with subsequent surgery. For those who receive antibiotics alone rather than surgery, following up with your medical team is particularly important due to the risk of incomplete cure and recurrence [3-6].
Questions Your Doctor May Ask to Determine Appendicitis
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you lost your appetite recently?
- Are you sick enough to consider going to the emergency room right now?
- Where is your abdominal pain?
- Is your abdominal pain getting better or worse?
- Is your abdominal pain constant or come-and-go?
If you've answered yes to one or more of these questions
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- Appendicitis. National Institute of Diabetes and Digestive and Kidney Disorders. NIDDK Link
- Appendicitis. U.S. National Library of Medicine: MedlinePlus. Updated December 3, 2018. MedlinePlus Link
- Snyder MJ, Guthrie M. Acute appendicitis: Efficient diagnosis and management. Am Fam Physician. 2018;98(1):25-33. AAFP Link
- D'Souza N, Nugent K. Appendicitis. Am Fam Physician. 2016;93(2):142-143. AAFP Link
- Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-4690. NCBI Link
- Amin P, Cheng D. Management of complicated appendicitis in the pediatric population: When surgery doesn't cut It. Semin Intervent Radiol. 2012;29(3):231-6. NCBI Link
- Elective coincidental appendectomy. American College of Obstetricians and Gynecologists: Committee Opinion. Published November 2005. ACOG Link
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