Appendicitis is a painful inflammation of the appendix, a small, finger-like pouch attached to the large intestine. The purpose of the appendix is unclear, and removing it does not cause harm.
Symptoms of Appendicitis
The symptoms of appendicitis usually develop quickly and can include:
- Abdominal Pain: Starts in the middle of the abdomen and often moves to the lower right side, becoming sharp and constant.
- Worsening Pain: Pain may intensify with movement, coughing, or pressure.
- Loss of Appetite: Feeling less interested in food.
- Nausea and Vomiting: Accompanied by abdominal discomfort.
- Digestive Symptoms: Diarrhoea, constipation, or bloating may occur.
If you experience severe, worsening pain or symptoms of appendicitis, seek medical help immediately, as a burst appendix can cause life-threatening complications.
Diagnosis of Appendicitis
To diagnose appendicitis, healthcare professionals will:
- Review symptoms and medical history.
- Perform a physical examination, including pressing on the abdomen.
- Order tests, such as:
- Blood Tests: To check for infection.
- Imaging Tests: An ultrasound, CT scan, or MRI may be used to visualize the appendix.
Treatment of Appendicitis
In most cases, appendicitis is treated through surgical removal of the appendix, known as an appendectomy. There are two main surgical options:
- Keyhole Surgery (Laparoscopy): Small incisions are made, and the appendix is removed using special instruments. Recovery is often quicker with this method.
- Open Surgery: A single, larger incision is made, typically used if the appendix has burst or is difficult to access.
Causes and Risk Factors
The exact cause of appendicitis isn’t fully understood. However, it is often triggered by a blockage in the appendix, leading to infection and inflammation. This blockage can result from:
- Hardened Stool (Faeces)
- Enlarged Lymph Nodes: Often linked to an infection elsewhere in the body.
Recovery After Surgery
- Keyhole Surgery: Recovery is typically within a couple of weeks.
- Open Surgery: Recovery may take longer, with strenuous activities limited for up to 6 weeks.
Who is Affected?
- Appendicitis is relatively common, with about 1 in 13 people affected in their lifetime.
- It most often occurs in young people aged 10 to 20 years old but can happen at any age.
Symptoms of Appendicitis
- Pain: Typically starts in the middle of the abdomen, often around the belly button, and can come and go. Within hours, it usually moves to the lower right-hand side of the abdomen and becomes constant and severe.
- Pain Sensitivity: Pain worsens when pressing on the area, coughing, or walking.
- Nausea and Vomiting: You may feel sick or vomit.
- Loss of Appetite: Many people with appendicitis lose interest in eating.
- Diarrhoea: Some people may experience diarrhoea.
- Fever: A high temperature and flushed face may occur.
When to Seek Medical Help:
- Gradually worsening abdominal pain: Contact your GP or local out-of-hours service.
- Severe Pain or Worsening Symptoms: Call NHS 24’s 111 service for advice, or dial 999 if the pain becomes intense, worsens, and spreads across your abdomen, as this may indicate a ruptured appendix.
Note: Symptoms of appendicitis may be confused with other conditions like gastroenteritis, IBS, urinary infections, or gynaecological issues. Any persistent and severe abdominal pain requires urgent medical evaluation to rule out serious complications, such as a burst appendix leading to peritonitis.
Diagnosing appendicitis
Diagnosing appendicitis can be challenging because symptoms vary and may mimic other conditions. Classic symptoms are only present in about half of all cases, and the location of the appendix may differ between individuals, making diagnosis more complex.
Appendix Location Variations:
- Pelvis: Lower position
- Behind the Large Intestine: Retrocecal
- Around the Small Bowel: Near the lower abdomen
- Near the Right Lower Liver: Higher location
Conditions with Similar Symptoms:
- Gastroenteritis
- Severe irritable bowel syndrome (IBS)
- Constipation
- Bladder or urinary infections
Initial Diagnosis:
- Symptom Check: Your GP will ask about your symptoms and medical history.
- Abdominal Examination: The doctor may press on the abdomen, especially the lower right-hand side, to see if the pain worsens.
- If symptoms strongly suggest appendicitis, a direct referral to the hospital is often made.
Further Tests:
When symptoms are not typical, additional tests may be done to confirm appendicitis or rule out other conditions:
- Blood Tests: To check for signs of infection.
- Pregnancy Test (for Women): To rule out pregnancy-related issues.
- Urine Test: To rule out bladder infections or other urinary issues.
- Ultrasound Scan: To check if the appendix is swollen.
- CT Scan: Provides detailed imaging of the abdomen to assess the appendix.
Laparoscopy:
- In uncertain cases, a laparoscopy (minimally invasive procedure) may be performed to directly inspect the appendix and pelvic organs.
- If appendicitis is suspected, removal of the appendix is often recommended to prevent the risk of rupture, even if the diagnosis is not 100% certain.
Observation Period:
- In some cases, a “watch-and-wait” approach for up to 24 hours may be recommended to see if symptoms worsen or improve.
Emergency Cases:
- If a burst appendix is suspected, immediate hospital treatment is required to manage potentially life-threatening complications like peritonitis.
Treating Appendicitis
Surgical Removal (Appendectomy):
- Purpose: In most cases of appendicitis, removing the appendix is necessary to prevent complications such as rupture.
- Why Surgery?: Surgery is often recommended even when appendicitis is suspected but not confirmed to avoid the risk of the appendix bursting.
Types of Surgery:
Keyhole Surgery (Laparoscopy):
- Preferred method due to quicker recovery.
- Involves making 3 or 4 small incisions.
- Instruments used:
- Tube to pump gas into the abdomen for visibility.
- Laparoscope (small camera).
- Surgical tools for appendix removal.
- Incisions are closed with dissolvable or regular stitches.
Open Surgery:
- Recommended if:
- The appendix has burst.
- The surgeon is less experienced with laparoscopy.
- The patient has had previous abdominal surgery.
- Involves a single, larger incision in the lower right abdomen.
- In cases of widespread peritonitis, a laparotomy (longer cut) may be necessary.
- Recommended if:
Recovery:
- Keyhole Surgery: Most patients leave the hospital within 24 hours.
- Open or Complicated Surgery: Hospital stay may last up to a week.
- Post-surgery symptoms include:
- Pain and bruising.
- Shoulder tip pain (after keyhole surgery) due to gas.
- Possible short-term constipation.
- Patients are advised on wound care and activity limitations. Normal activities can resume in a few weeks, but strenuous activities may need to wait 4 to 6 weeks after open surgery.
When to Seek Medical Advice:
- Increasing pain or swelling.
- Vomiting.
- High fever.
- Discharge or warmth from the wound.
- These may indicate infection.
Risks and Complications:
- Common risks include infection, scarring, haematoma, abscess, or hernia.
- Risks of general anaesthetic are minimal but can include allergic reactions or rare complications like pneumonia.
Alternatives to Emergency Surgery:
- Appendix Mass: If a lump forms, antibiotics may be prescribed initially, with surgery planned later.
- Antibiotics Alone: This approach is still under study and lacks sufficient evidence as a definitive alternative to surgery.
Complications of Appendicitis
Diverticular Disease and Diverticulitis
