| What Is Appendicitis? |
The appendix is a small, finger-shaped pouch that projects out from your colon on the right-hand side. The appendix has no known purpose, but that doesn’t mean it can’t cause problems. In fact, every year about 7 percent of Americans develop appendicitis — a condition in which the appendix becomes inflamed and filled with pus.
The main symptom of appendicitis is pain that begins around the navel and then shifts to the lower-right abdomen. The pain usually increases over a period of 12 to 24 hours, and eventually may be very severe.
Anyone can develop appendicitis, but it most often strikes people between the ages of 10 and 30 and is one of the most common reasons for emergency abdominal surgery in children.
The standard treatment for appendicitis is surgical removal of the appendix (appendectomy). In many cases the surgery is straightforward and you recover quickly. But if your appendix has ruptured, the surgery may be more complicated and you’ll take longer to heal. A ruptured appendix that's not promptly treated can lead to serious complications such as an infection of the abdominal lining (peritonitis) or a walled-off area of infection (an abscess). In rare instances a ruptured appendix may be fatal.
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| Signs and Symptoms |
Appendicitis can cause a variety of symptoms that may change over time. The most obvious early symptom is an aching pain around your navel that often shifts to your lower-right abdomen. As the inflammation in your appendix spreads to nearby tissues, the pain may become sharper and more severe.
Eventually the pain tends to settle in your lower-right abdomen just above your appendix at what's known as McBurney's point. This point is about halfway between your navel and your right pelvic bone. But the location of your pain may vary, depending on your age and the position of your appendix. Young children, especially, may have appendicitis pain in different places.
If you apply gentle pressure to the area that hurts, it will feel tender. As you release the pressure, appendicitis pain often will feel worse (rebound tenderness). It will also tend to get worse if you cough, walk or make other jarring movements. The pain may lessen somewhat if you lie on your side and pull your legs up beneath you.
In addition to pain, you may have one or more of the following symptoms:
- Nausea and sometimes vomiting
- Loss of appetite
- A low-grade fever that starts after other symptoms appear
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| Causes |
It's not always clear why appendicitis occurs. Sometimes it's the result of an obstruction when food waste or a hard piece of stool (fecal stone) becomes trapped in the cavity that runs the length of your appendix.
Appendicitis may also follow an infection, especially a gastrointestinal viral infection, or it may result from other types of inflammation. In both cases, bacteria may subsequently grow rapidly, causing the appendix to become inflamed and filled with pus. If not treated promptly, your appendix eventually may rupture.
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| Screening and Diagnosis |
The pain from appendicitis may change over time, so establishing a diagnosis can sometimes be difficult. In addition, abdominal pain can arise from a number of health problems other than appendicitis. This is particularly true for young women who may have pain from a pregnancy that occurs outside the lining of the uterus (ectopic pregnancy) or from the rupture of an ovarian cyst.
To help diagnose appendicitis, your doctor will likely take your temperature and examine your abdomen. When gentle pressure on the painful area is suddenly released, appendicitis pain will often feel worse. Your doctor may also perform a rectal exam and, if you're a woman, a pelvic exam to determine the extent and exact location of your pain.
In addition, your doctor will usually recommend a blood test to check for a high white blood cell count, which may indicate an infection. He or she may also want you to have a urinalysis to make sure that a urinary tract infection isn't causing your pain.
Your doctor also may recommend an abdominal X-ray or ultrasound scan to help confirm appendicitis or find other causes for your pain. An ultrasound scan uses high-frequency sound waves and computer technology to provide images of your internal organs. Sometimes a computerized tomography (CT) scan may also be done. A CT scan is a diagnostic imaging procedure that uses a series of computer-generated X-rays to provide a more comprehensive view of your internal organs than conventional X-rays.
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| Complications |
The most serious complication of appendicitis is an infection of the lining of your abdominal cavity (peritonitis). This may occur if your appendix ruptures (perforates) and the contents of your intestines as well as the infection invade the peritoneal cavity. When this happens, your entire abdomen may become distended with gas and fluid and will likely feel tight and hard to the touch. You'll also have pain throughout your abdomen, but may not have the severe, localized pain of appendicitis. In addition, you may not be able to pass gas or have a bowel movement, and you may have a fever, thirst and a low urine output.
Peritonitis is a medical emergency. If you or a family member develops signs of this abdominal infection, go to an emergency room immediately. Even with prompt treatment, peritonitis can be extremely serious.
Children are more likely to have a ruptured appendix than adults are. They don't always have typical symptoms of appendicitis, and parents may delay getting treatment. For that reason, it's best not to take abdominal pain lightly. Even if you suspect a "stomach ache" isn't serious, call your doctor just to make sure.
Sometimes, the seepage of intestinal contents and infection may occur as an abscess, a walled-off area of infection. The abscess may be as small as a walnut or as large as a grapefruit. But no matter what its size, it requires surgery before the abscess itself perforates, causing peritonitis.
| Treatment |
If you have acute appendicitis, you'll need to have your appendix surgically removed (appendectomy). Your surgeon may perform traditional open surgery, using a single long abdominal incision, or choose laparoscopic surgery, which requires only a few small abdominal incisions.
In a laparoscopic procedure, your surgeon inserts a laparoscope a pencil-thin tube with its own lighting system and miniature video camera into your abdomen through a hollow instrument (cannula). Only a small incision is required. The video camera then produces a magnified view of the inside of your abdomen on an outside video monitor. This allows your surgeon to see the surgery in detail. To remove your appendix, your surgeon uses tiny instruments inserted through several other small abdominal incisions.
In general, laparoscopic surgery will allow you to recover faster and heal with less scarring. But if your appendix has ruptured and infection has spread beyond the appendix, a larger incision will be needed so your surgeon can clean the abdominal cavity. You’ll receive intravenous antibiotics and will need to stay in the hospital during your recovery.
— January 31, 2002 —