Acute appendicitis

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Appendicitis happens when your appendix becomes inflamed. It can be acute or chronic.

In the United States, appendicitis is the most common cause of abdominal pain resulting in surgery. Over 5 percent of Americans experience it at some point in their lives.

If left untreated, appendicitis can cause your appendix to burst. This can cause bacteria to spill into your abdominal cavity, which can be serious and sometimes fatal.

Read on to learn more about the symptoms, diagnosis, and treatment for appendicitis.

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

Causes

In many cases, the exact cause of appendicitis is unknown. Experts believe it develops when part of the appendix becomes obstructed, or blocked.

Many things can potentially block your appendix, including:

• a buildup of hardened stool
• enlarged lymphoid follicles
• intestinal worms
• traumatic injury
• tumors

When your appendix becomes blocked, bacteria can multiply inside it. This can lead to the formation of pus and swelling, which can cause painful pressure in your abdomen.

Other conditions can also cause abdominal pain. Click here to read about other potential causes of pain in your lower right abdomen.

Symptoms

Signs and symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower abdomen
• Sudden pain that begins around your navel and often shifts to your lower right abdomen
• Pain that worsens if you cough, walk or make other jarring movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the illness progresses
• Constipation or diarrhea
• Abdominal bloating
• Flatulence

The site of your pain may vary, depending on your age and the position of your appendix. When you’re pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

When to see a doctor

Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention

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Complications

Appendicitis can cause serious complications, such as:

• A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
• A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you’re given antibiotics to clear the infection. Once the infection is clear, you’ll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

Diagnosis

Diagnosing appendicitis can be tricky. Symptoms  are often unclear or similar to those of other illnesses, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, kidney stones, intestinal infection, and ovary problems.

These tests can help diagnose appendicitis:

• Examination of your abdomen to look for inflammation
• Urine (pee) test to rule out a urinary tract infection
• Rectal exam
• Blood test to see whether your body is fighting an infection
• CT scans
• Ultrasound

Tests for appendicitis

If your doctor suspects you might have appendicitis, they will perform a physical exam. They will check for tenderness in the lower right part of your abdomen and swelling or rigidity.

Depending on the results of your physical exam, your doctor may order one or more tests to check for signs of appendicitis or rule out other potential causes of your symptoms.

There’s no single test available to diagnose appendicitis. If your doctor can’t identify any other causes of your symptoms, they may diagnose the cause as appendicitis.

Complete blood count

To check for signs of infection, your doctor may order a complete blood count (CBC). To conduct this test, they will collect a sample of your blood and send it to a lab for analysis.

Appendicitis is often accompanied by bacterial infection. An infection in your urinary tract or other abdominal organs may also cause symptoms similar to those of appendicitis.

Urine tests

To rule out urinary tract infection or kidney stones as a potential cause of your symptoms, your doctor may use urinalysis. This is also known as a urine test.

Your doctor will collect a sample of your urine that will be examined in a lab.

Pregnancy test

Ectopic pregnancy can be mistaken for appendicitis. It happens when a fertilized egg implants itself in a fallopian tube, rather than the uterus. This can be a medical emergency.

If your doctor suspects you might have an ectopic pregnancy, they may perform a pregnancy test. To conduct this test, they will collect a sample of your urine or blood. They may also use a transvaginal ultrasound to learn where the fertilized egg has implanted.

Pelvic exam

If you’re female, your symptoms might be caused by pelvic inflammatory disease, an ovarian cyst, or another condition affecting your reproductive organs.

To examine your reproductive organs, your doctor may perform a pelvic exam.

During this exam, they will visually inspect your vagina, vulva, and cervix. They will also manually inspect your uterus and ovaries. They may collect a sample of tissue for testing.

Abdominal imaging tests

To check for inflammation of your appendix, your doctor might order imaging tests of your abdomen. This can also help them identify other potential causes of your symptoms, such as an abdominal abscess or fecal impaction.

Your doctor may order one or more of the following imaging tests:

• abdominal ultrasound
• abdominal X-ray
• abdominal CT scan
• abdominal MRI scan

In some cases, you might need to stop eating food for a period of time before your test. Your doctor can help you learn how to prepare for it.

Chest imaging tests

Pneumonia in the lower right lobe of your lungs can also cause symptoms similar to appendicitis.

If your doctor thinks you might have pneumonia, they will likely order a chest X-ray. They may also order a CT scan to create detailed images of your lungs

Treatment

Appendicitis is almost always treated as an emergency.  Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis.

Generally, if your doctor suspects that you have appendicitis, they will quickly remove it to avoid a rupture. If you have an abscess, you may get two procedures: one to drain the abscess of pus and fluid, and a later one to take out the appendix. But some research shows that treating acute appendicitis with antibiotics may help you avoid surgery.

Depending on your condition, your doctor’s recommended treatment plan for appendicitis may include one or more of the following:

• surgery to remove your appendix
• needle drainage or surgery to drain an abscess
• antibiotics
• pain relievers
• IV fluids
• liquid diet

In rare cases, appendicitis may get better without surgery. But in most cases, you will need surgery to remove your appendix. This is known as an appendectomy.

If you have an abscess that hasn’t ruptured, your doctor may treat the abscess before you undergo surgery. To start, they will give you antibiotics. Then they will use a needle to drain the abscess of pus.

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Surgery for appendicitis

To treat appendicitis, your doctor may use a type of surgery known as appendectomy. During this procedure, they will remove your appendix. If your appendix has burst, they will also clean out your abdominal cavity.

In some cases, your doctor may use laparoscopy to perform minimally invasive surgery. In other cases, they may have to use open surgery to remove your appendix.

Like any surgery, there are some risks associated with appendectomy. However, the risks of appendectomy are smaller than the risks of untreated appendicitis.

Acute appendicitis

Acute appendicitis is a severe and sudden case of appendicitis. The symptoms tend to develop quickly over the course of one to two daysTrusted Source.

It requires immediate medical treatment. If left untreated, it can cause your appendix to rupture. This can be a serious and even fatal complication.

Acute appendicitis is more common than chronic appendicitis.

Chronic appendicitis

Chronic appendicitis is less common than acute appendicitis. In chronic cases of appendicitis, the symptoms may be relatively mild. They may disappear before reappearing again over a period of weeks, months, or even years.

This type of appendicitis can be challenging to diagnose. Sometimes, it’s not diagnosed until it develops into acute appendicitis.

Chronic appendicitis can be dangerous.

Appendicitis in kids

An estimated 70,000 children experience appendicitis every year in the United States. Although it’s most common in people between the ages of 15 and 30 years old, it can develop at any age.

In children and teenagers, appendicitis often causes a stomachache near the navel. This pain may eventually become more severe and move to the lower right side of your child’s abdomen.

Your child may also:

• lose their appetite
• develop a fever
• feel nauseous
• vomit

If your child develops symptoms of appendicitis, contact their doctor right away.

Recovery time for appendicitis

Your recovery time for appendicitis will depend on multiple factors, including:

• your overall health
• whether or not you develop complications from appendicitis or surgery
• the specific type of treatments you receive

If you have laparoscopic surgery to remove your appendix, you may be discharged from the hospital a few hours after you finish surgery or the next day.

If you have open surgery, you will likely need to spend more time in the hospital to recover afterward. Open surgery is more invasive than laparoscopic surgery and typically requires more follow-up care.

Before you leave the hospital, your healthcare provider can help you learn how to care for your incision sites. They may prescribe antibiotics or pain relievers to support your recovery process. They may also advise you to adjust your diet, avoid strenuous activity, or make other changes to your daily habits while you heal.

It may take several weeks for you to fully recover from appendicitis and surgery. If you develop complications, your recovery may take longer.

Appendicitis in pregnancy

Acute appendicitis is the most common non-obstetric emergency requiring surgery during pregnancy. It affects an estimated 0.04 to 0.2 percent of pregnant women.

The symptoms of appendicitis may be mistaken for routine discomfort from pregnancy. Pregnancy may also cause your appendix to shift upward in your abdomen, which can affect the location of appendicitis-related pain. This can make it harder to diagnose.

Treatment options during pregnancy might include one or more of the following:

• surgery to remove your appendix
• needle drainage or surgery to drain an abscess
• antibiotics

Delayed diagnosis and treatment may increase your risk of complications, including miscarriage.

Potential complications of appendicitis

Appendicitis can cause serious complications. For example, it may cause a pocket of pus known as an abscess to form in your appendix. This abscess may leak pus and bacteria into your abdominal cavity.

Appendicitis can also lead to a ruptured appendix. If your appendix ruptures, it can spill fecal matter and bacteria into your abdominal cavity.

If bacteria spill into your abdominal cavity, it can cause the lining of your abdominal cavity to become infected and inflamed. This is known as peritonitis, and it can be very serious, even fatal.

Bacterial infections can also affect other organs in your abdomen. For example, bacteria from a ruptured abscess or appendix may enter your bladder or colon. It may also travel through your bloodstream to other parts of your body.

To prevent or manage these complications, your doctor may prescribe antibiotics, surgery, or other treatments. In some cases, you might develop side effects or complications from treatment. However, the risks associated with antibiotics and surgery tend to be less serious than the potential complications of untreated appendicitis.

Preventing appendicitis

There’s no sure way to prevent appendicitis. But you might be able to lower your risk of developing it by eating a fiber-rich diet. Although more research is needed on the potential role of diet, appendicitis is less common in countries where people eat high-fiber diets.

Foods that are high in fiber include:

• fruits
• vegetables
• lentils, split peas, beans, and other legumes
• oatmeal, brown rice, whole wheat, and other whole grains

Your doctor may also encourage you to take a fiber supplement.

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