- Blocked Appendix Opening: Hard stool, enlarged lymphoid follicles, or other materials can block the appendix, leading to inflammation and bacterial growth.
- Family History: Individuals with first-degree relatives who had appendicitis face higher occurrence rates.
- Age: Cases peak between ages 10 and 30, though appendicitis can occur at any age.
- Gender: Males experience a slightly higher rate of appendicitis compared to females.
- Gastrointestinal Infection: Prior GI infections may increase the risk of developing appendicitis.
Appendicitis
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Appendicitis occurs when the appendix becomes inflamed and fills with pus, causing severe abdominal pain. This condition typically begins with pain near the navel that moves to the lower right abdomen as inflammation increases. Without prompt medical treatment, the appendix can rupture within 24-72 hours of symptom onset, leading to serious complications, including peritonitis, a widespread infection of the abdominal cavity.
Symptoms of Appendicitis
The development of appendicitis symptoms reflects the severity and stage of the inflammation. Primary symptoms include:
- Abdominal Pain: Pain begins around the navel and typically shifts to the lower right abdomen within several hours. The pain intensifies with movement or coughing.
- Loss of Appetite: A sudden decrease in appetite often occurs, accompanied by nausea or vomiting after the pain begins.
- Fever: A low-grade fever between 37.5°C and 38.5°C develops as the body responds to the infection.
- Rebound Tenderness: Sharp pain occurs when pressure on the lower right abdomen is suddenly released, indicating peritoneal inflammation.
- Constipation or Diarrhoea: Changes in bowel habits occur as the appendix inflammation affects surrounding intestinal tissue.
- Bloating and Gas: The abdomen becomes distended and tender due to inflammatory changes in the digestive system.
Causes and Risk Factors
Several factors can lead to appendicitis development, with obstruction being the primary trigger.
Types of Appendicitis
Appendicitis manifests in two primary forms, each influencing the urgency and method of treatment.
Acute Appendicitis
Develops rapidly over 24-48 hours. The appendix becomes increasingly inflamed and painful as bacteria multiply within the blocked organ. Without treatment, the appendix can rupture, leading to peritonitis. This type requires immediate surgical intervention to prevent life-threatening complications.
Chronic Appendicitis
Symptoms develop over an extended period, often weeks or months, and may disappear and recur. The inflammation persists at a lower level, causing intermittent pain that can be mistaken for other conditions. Patients may experience several episodes before receiving a correct diagnosis. This rare form affects approximately 1.5% of all appendicitis cases.
Diagnostic Methods
Physical Examination
A doctor checks for abdominal tenderness, rebound pain, and other physical signs. Specific tests, such as the Rovsing sign, where pressure on the left side causes pain on the right, help diagnose appendicitis.
Blood Tests
A complete blood count reveals elevated white blood cell levels, indicating infection. Other blood markers help assess inflammation severity and differentiate appendicitis from other conditions.
Imaging Studies
CT scans offer detailed views of the appendix and surrounding tissues, with 98% accuracy in diagnosis. Ultrasound serves as an alternative, particularly for children and pregnant women, showing appendix inflammation and surrounding fluid collection.
Urine Analysis
This test helps exclude urinary tract conditions that can mimic appendicitis symptoms. It rules out kidney stones and bladder infections that present with similar pain patterns.
Treatment Options
Treatment approaches vary based on the severity of appendicitis and the patient’s overall health status.
Non-Surgical Treatment
- Antibiotics: Select cases of early, uncomplicated appendicitis may respond to antibiotic therapy alone. This approach requires careful monitoring and has a 30% chance of recurrence within one year. Treatment typically involves intravenous antibiotics for 24-48 hours, followed by oral antibiotics for 7-10 days.
- Conservative Management: Some patients who cannot undergo immediate surgery may receive temporary conservative treatment. This includes bowel rest, intravenous fluids, and antibiotics while preparing for delayed surgery.
Surgical Treatment
- Laparoscopic Appendectomy: This minimally invasive procedure involves removing the appendix through small incisions using specialised instruments and a camera. It is typically performed for uncomplicated cases and offers a faster recovery time of 1-2 weeks, minimal scarring, and reduced post-operative pain.
- Open Appendectomy: For more complex cases, such as a ruptured appendix or the presence of an abscess, a traditional open surgery is required. This approach uses a larger incision, allowing better access to clean the abdominal cavity if contamination has occurred. Recovery generally takes 2-4 weeks, making it more suitable for addressing severe complications.
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Prevention of Appendicitis
A high-fibre diet, including fresh fruits, vegetables, whole grains, and legumes, helps maintain healthy bowel function and may lower the risk of appendicitis by preventing blockages in the appendix. Regular exercise also supports digestive health and reduces the likelihood of issues contributing to inflammation. While appendicitis cannot always be prevented, early recognition of symptoms such as abdominal pain, nausea, and fever ensures prompt treatment, reducing the risk of complications and improving outcomes.
Frequently Asked Questions
What are the warning signs of a ruptured appendix?
A sudden relief from abdominal pain, followed by a rapid worsening of symptoms such as severe abdominal tenderness, high fever, a rapid heart rate, and mental confusion, may indicate a ruptured appendix.
Is recurrent appendicitis possible?
Yes, chronic or recurrent appendicitis can occur, causing repeated episodes of mild or intermittent inflammation. These episodes often lead to eventual surgical intervention to prevent further complications.
Are there long-term effects of living without an appendix?
No significant long-term effects have been identified after an appendectomy. The body adapts well to the absence of the appendix, and its removal does not impact overall digestive or immune health.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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