Appendicitis | Appendectomy (Appendix Removal)

What is Appendicitis?

Appendicitis is the inflammation of the appendix, a tiny organ found in the lower right part of the abdomen. It is a common condition, with up to 7 percent of the population being affected by it. Appendicitis can affect people of all ages and genders, but is most commonly seen in people between 10 and 30 years old.

Appendicitis is a serious condition that requires prompt medical attention. If left untreated, it can lead to the appendix bursting and causing a life-threatening bacterial infection. The signs and symptoms of appendicitis may start off mild and be mistaken for indigestion or stomach flu. 

The pain typically begins around the navel or upper abdomen, and will usually worsen and localize to the right lower abdomen within one or two days. Other symptoms can include nausea, vomiting, fever, loss of appetite, and constipation or diarrhea. If you experience severe abdominal pain, seek medical attention right away.

A doctor will be able to diagnose appendicitis through a physical examination and laboratory tests, such as a blood test or a CT Scan. If appendicitis is diagnosed, the patient will need to have surgery to remove the appendix. This surgery is known as an appendectomy. 

What is the Appendix?

The appendix is a small, thin tube connected to the large intestine located in the lower right area of the abdomen. It functions as an immunological organ when a person is a child, helping the body fight off disease. However, as a person grows older, the appendix stops performing this task and other organs take over its duties.

Although the appendix is no longer a working part of our immune system, it has a few other possible functions. For example, it can help to control the levels of bacteria in the intestines, as well as being a source of stem cells. It is also believed to be involved in the growth and development of the embryo.

What Causes Appendicitis?

The most common cause of appendicitis is a blockage of the appendix, which is the thin, tube-like structure that is located at the end of the large intestine. This blockage can be caused by a variety of factors, including the accumulation of stool or mucus, an infection in the digestive tract, or a tumor in the area.

Another potential cause of appendicitis is a viral infection, such as the one that causes a stomach bug. Viruses can cause inflammation of the appendix and other parts of the digestive tract. In some cases, appendicitis may be caused by a structural abnormality of the appendix. This abnormality can be present from birth or may develop over time.

Finally, appendicitis may also be caused by the immune system mistakenly attacking the appendix. This is known as an autoimmune condition and can be caused by a variety of things, including allergies or medications. No matter the cause, appendicitis is a serious medical condition and can lead to severe complications if left untreated. 

Who is at Risk for Appendicitis?

While it is true that anyone can be affected by appendicitis, some individuals are more likely to develop the condition than others. For example, children who have cystic fibrosis are at an increased risk of being affected by appendicitis. Both gender are susceptible to this condition with a slight increased in incidence in males. 

There is a higher incidence of appendicitis in younger people whom are less than 30 years old. However, this can still occur in the older age group as well. The older the patient with the diagnosis of appendicitis, the more important it is to exclude secondary causes of appendicitis like a tumor or polyp causing obstruction at the appendiceal orifice. 

What are the Symptoms of Appendicitis?

The symptoms of appendicitis can range from mild to more severe, depending on the individual and the severity of the condition. In general, the most common symptom of appendicitis is abdominal pain. This pain typically begins around the belly button and then moves to the lower right side of the abdomen. It may worsen over time and be worsened by movement, taking deep breaths, being touched, coughing, or sneezing. 

If the appendix has already ruptured, the pain may be felt throughout the abdomen. Other symptoms of appendicitis include:

  • Nausea and vomiting
  • Loss of appetite
  • Fever and chills
  • Constipation
  • Diarrhea
  • Difficulty passing gas
  • Swelling in the abdomen

It’s important to note that the symptoms of appendicitis can resemble other medical issues. Therefore, it’s important to seek medical attention if you’re experiencing any of the above symptoms. Your healthcare provider can properly diagnose the condition and provide the appropriate treatment.

How is Appendicitis Diagnosed?

When diagnosing appendicitis, doctors will typically look for a combination of symptoms, such as pain in the lower right-hand side of the abdomen, fever, nausea, vomiting, and loss of appetite. A physical exam may be done to check for tenderness of the abdomen and the presence of fever. The typical finding of rebound tenderness over the McBurney’s point is a classical sign for appendicitis. The other less common finding is Rovsing’s sign, when pain is experienced on palpation over the opposite side of the abdomen! 

The doctor may also order a blood test to look for signs of infection and an imaging test such as an abdominal CT scan. Less commonly an ultrasound or MRI is used to confirm the diagnosis and this is usually done in children and pregnant ladies to avoid the effect of radiation in the more susceptible populations.  The most reliable way to confirm the presence of appendicitis is by using a laparoscopy, which involves the insertion of a small camera through a small incision in the abdomen to examine the appendix. 

Early diagnosis is key to avoid further complications such as a rupture of the appendix, which can lead to a life-threatening infection. Treatment for acute appendicitis typically involves antibiotics and surgery to remove the appendix. Surgery is usually recommended for cases of appendicitis due to the risk of rupture.

What are the Dangers of Appendicitis?

If left untreated, appendicitis can become life-threatening. The most serious complications arise when the appendix ruptures, leading to a spreading infection. When the appendix becomes inflamed, it can swell, blocking the flow of fluids and waste in the abdominal area. 

This can lead to a buildup of pressure, which can cause the appendix to burst, releasing bacteria and other toxins into the abdominal cavity. It is important to seek medical attention immediately if you experience any of the symptoms of appendicitis. 

Early treatment can help to reduce the risk of complications and can even prevent the appendix from bursting. Seek medical attention as soon as possible, even if you are only experiencing mild symptoms. 

If the appendix ruptures, an abscess may form and bacteria may spread to the entire abdomen, causing a serious condition called peritonitis, an inflammation of the abdominal wall lining. If the appendix does rupture, then surgery is typically necessary to remove the abscess. 

Very young children (aged two and below) and the elderly (aged 70 and above) are also at higher risk for a ruptured appendix. It is important for these age groups to seek medical attention immediately if they experience any abdominal pain.

How is Appendicitis Treated?

The treatment for appendicitis depends on the severity of the condition. If the appendix has not yet burst, the doctor will likely recommend surgery to remove the appendix. This type of surgery is called an appendectomy.

During surgery, the surgeon will make a small incision in the lower right side of the abdomen. The surgeon will then locate the appendix and remove it. After the appendix is taken out, the incision will be closed with stitches. 

In many cases, the appendix can be removed without any major complications. In situations where the appendix has already burst, your doctor may recommend a procedure called a laparotomy. 

During a laparotomy, the surgeon will make a larger incision in the abdomen to allow for drainage of the pus and fluid that has accumulated in the abdomen. The surgeon will then remove the appendix and any other infected tissue. 

In some cases, doctors may recommend antibiotics to treat the infection associated with mild appendicitis. Though mostly effective in such patients, the estimated risk of recurrence is in excess of 15%. This percentage goes higher when there is presence of a phelgmon or an appendicolith (stone in the appendix). Therefore, the more common treatment remains to be surgery.

What are the Possible Complications of Appendicitis?

The most serious complication of appendicitis is a burst appendix. If a person has appendicitis and does not receive timely medical attention, the appendix can become so inflamed that it eventually ruptures, leading to leakage of intestinal contents into the abdomen. 

This is a very serious complication as it can lead to infection of the abdomen, known as peritonitis. Peritonitis is a severe infection of the abdominal cavity and can be life-threatening. It is caused by bacteria traveling through the bloodstream from the burst appendix.

If peritonitis is left untreated, it can cause serious damage to the abdominal organs and even cause death. This is why it is so important to seek medical attention immediately after experiencing symptoms of appendicitis. In some cases, a burst appendix can lead to an abscess, which is a pocket of pus that can form in the abdominal region. 

An abscess can cause pain, fever and other complications, and may require further treatment or surgery. Other potential complications of appendicitis include blockages in the intestine, which can cause nausea, vomiting and abdominal pain. These blockages can occur if the appendix has become twisted.

It also occurs if scar tissue has formed around the appendix. In rare cases, appendicitis can cause a serious complication known as sepsis. Sepsis is caused by a bacterial infection that spreads throughout the body, and can be very dangerous. It is important to seek medical attention if you experience any signs of sepsis. 

Although appendicitis can be a very serious condition, with timely treatment, it is usually possible to overcome the condition with minimal or no complications. If you experience any symptoms of appendicitis, it is important to seek medical attention to ensure that the condition is properly treated and that any potential complications are avoided.

Frequently Asked Questions

  • On what side is the appendix located?

    The appendix is located on the right side of the abdomen. In a congenital condition known as situs inversus, the appendix can be located on the left side. In another congenital condition known as gut malrotation, the appendix can be located higher or even in the center part of the abdomen

  • What is appendicitis?

    The appendix is a vermiform appendage that is attached to the first part of the large intestine. Appendicitis basically refers to the inflammation of the appendix. Despite having lymphoid tissue, the appendix has no critical function and can be safely removed via surgery when inflamed.

    Most appendicitis are removed via laparoscopy or keyhole surgery. In complicated cases where there is an appendicular phlegmon, it might be necessary to delay surgery to minimize the morbidity of a more extensive surgery.

    The recovery usually includes 1-2 days of hospital stay and the patient resumes oral diet almost immediately after surgery depending on the severity of the appendicitis on presentation.

  • Is there a clear cause for appendicitis?

    There is no clear cause for appendicitis. The 2 common hypotheses are obstruction or an initial infection resulting in the swelling of the appendix due to the presence of lymphoid tissue. The common myth of chili seeds and physical activity after meals causing appendicitis has been disputed.

  • Is appendicitis a medical emergency?

    Early detection and treatment for appendicitis is necessary to prevent the more severe consequences of appendicitis. Most patients with appendicitis are referred to the emergency department in hospitals. At the hospital, an urgent CT scan may be performed to confirm the diagnosis of appendicitis and a surgery may be performed within the next 24 hours.

  • What are the long-term consequences of an appendectomy?

    As the appendix has no critical function in the body, it can be safely removed when indicated. The appendix itself doesn’t add to the digestion or normal motility of the gut. However, appendectomy being a surgical procedure can still have its long-term consequences.

    Firstly, adhesions can form in the abdomen after any surgery. Adhesions are fibrous bands that form between intestinal loops as a result of inflammation. The inflammation can be due to infection or after any abdominal surgery which is different from congenital adhesions.

    The possible consequences of adhesions are asymptomatic, persistent abdominal colic or intestinal blockage. In order to prevent adhesions, early detection and treatment of appendicitis can minimize the peritoneal irritation and inflammation. Furthermore, a keyhole operation has reduced risk of adhesion formation when compared to a conventional open surgery.

    Secondly, hernia at the incision site can also occur. The overall risk for this is very low especially if the surgery was done via laparoscopy. This condition is also known as incisional hernia. It usually presents with swelling or persistent pain over the incision site and will usually require a consult. If left untreated, the hernia can continue to increase in size and cause intestinal blockage.

  • Is surgery the only way to treat appendicitis?

    Surgery is not the only way to treat appendicitis. Antibiotics alone have been effective in treating appendicitis especially in mild appendicitis. However, there is the risk of recurrence of appendicitis in such cases whereas in surgery, the entire appendix is removed and recurrence is extremely rare. In patients who are not fit for surgery, or when surgery carries a significant undesired risk like in pregnant ladies with appendicitis, antibiotics alone can be indicated.

  • How do I know if it’s appendix pain?

    The classical pain for appendicitis is a pain that begins in the center part of the abdomen and radiates to the right lower side. This pain is usually intermittent at its onset, but gradually becomes constant and increases in severity over time. Without treatment, this pain is unlikely to resolve by itself. There are other symptoms associated with appendicitis and these include fever, nausea and abdominal distension.

  • When do appendicitis symptoms start?

    There is no fixed duration to when the symptoms start. When appendicitis occurs, most patients will experience pain within a day. This pain is a result of peritoneal irritation which is a lining that covers all abdominal organs. However, the duration that this occurs varies due to variations of appendix location in human anatomy.

    For example, the appendix when located behind the ceacum, also known as retrocaecal, is not exposed to the peritoneal lining and hence it will take a longer duration of time for patients to experience the classical pain for appendicitis.