APPENDICITIS: General health Overview( Causes, Symptoms & Treatment)

What is 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.

The appendix is a thin tube that is joined to the large intestine. It sits in the lower right part of your belly (abdomen). When you are a young child, your appendix is a working part of your immune system, which helps your body to fight disease.

Acute appendicitis

Acute appendicitis is a severe and sudden case of appendicitis. It’s most common in children and young adults between the ages 10 and 30 years oldTrusted Source and occurs more frequently in males than females. Pain tends to develop and intensify quickly over the course of 24 hours.

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, occurring in about 7 to 9 percent of all Americans in their lifetime. Learn more about the similarities and differences between these conditions.

Chronic appendicitis

Chronic appendicitis is less common than acute appendicitis. It occurs in only about 1.5 percent of all people who have already had a case of chronic appendicitis.

In chronic cases of appendicitis, the symptoms may be relatively mild and are thought to usually occur following a case of acute appendicitis. Symptoms 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. Get the information you need to recognize and treat this condition.

SYMPTOMS

Appendicitis pain often starts off as mild cramping in your upper abdomen or bellybutton area that then moves to the lower right quadrant of your abdomen. This pain often:

  • begins suddenly
  • gets worse when you move or cough
  • is so intense that it wakes you from sleep
  • is severe and different from other abdominal pain you’ve experienced
  • worsens within a few hours

Other symptoms of appendicitis may include:

Less commonly, you may experience bowel problems including:

If you’re constipated and you suspect that you may have appendicitis, avoid taking laxatives or using an enema. These treatments may cause your appendix to burst.

Contact your doctor if you have tenderness in the right side of your abdomen along with any of other symptoms of appendicitis. Appendicitis can quickly become a medical emergency. Get the information you need to recognize this serious condition.

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

CAUSES

There are numerous issues that can cause appendix luminal blockage, including:

  • Appendicoliths or fecaliths, which are calcified fecal deposits, also known as “appendix stones” (this is more common in children than adults).
  • Intestinal worms or parasites, including pinworm (Enterobius vermicularis)
  • Irritation and ulcers in the gastrointestinal (GI) tract resulting from long-lasting disorders, such as Crohn’s disease or ulcerative colitis
  • Abdominal injury or trauma
  • Enlarged lymph tissue of the wall of the appendix, which is typically the result of infections in the GI tract
  • Benign or malignant tumors
  • Various foreign objects, such as stones, bullets, air gun pellets, and pins

Sometimes appendicitis is due to a viral, bacterial, or fungal infection that has spread to the appendix. Possible causes of infection include, but are not limited to:

  • E. coli, which are bacteria found in the environment, foods, and intestines of animals. Most strains of E. coli are harmless, but others can cause illness.
  • Pseudomonas bacteria, which are found in soil and water and moist areas such as sinks and toilets
  • Bacteroides, bacteria that already inhabit the digestive tract of humans
  • Adenovirus, a very common virus spread through contact or through the air that can cause cold-like symptoms as well as bladder and other infections.
  • Salmonella, a foodborne bacteria that typically causes gastrointestinal upset (diarrhea, nausea, and vomiting) but can have serious complications
  • Shigella bacteria, germs that are very contagious and typically result in diarrheal illness that usually lasts no more than a week.
  • Measles, a highly contagious virus spread through the air and contact. Vaccination protects most of the population, but there are outbreaks in which unvaccinated people are susceptible
  • The fungal infections mucormycosis (a rare but serious mold infection caused by environmental molds) and histoplasmosis; most people who breathe in these spores won’t get sick or will have mild symptoms, but infection can become severe in people with weakened immune systems

TREATMENT

If you have appendicitis, your appendix will usually need to be removed as soon as possible. This operation is known as an appendicectomy or appendectomy.

Surgery is often also recommended if there’s a chance you have appendicitis but it’s not been possible to make a clear diagnosis.

This is because it’s considered safer to remove the appendix than risk it bursting.

In humans, the appendix does not perform any important function and removing it does not cause any long-term problems.

Appendicectomy (appendectomy)

Removal of the appendix is carried out under general anaesthetic using either keyhole or open surgery.

Keyhole surgery

Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery.

The operation involves making 3 or 4 small cuts (incisions) in your tummy (abdomen).

Special instruments are inserted, including:

  • a tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work
  • a laparoscope – a small tube with a light and a camera, which relays images of the inside of the abdomen to a television monitor
  • small surgical tools used to remove the appendix

After your appendix has been removed, dissolvable stitches may be used to close the incisions. 

If regular stitches are used, they’ll need to be removed at your GP surgery 7 to 10 days later.

Open surgery

In some circumstances, keyhole surgery is not recommended and open surgery is used instead.

These include:

  • when the appendix has already burst and formed a lump called an appendix mass
  • when the surgeon is not experienced in laparoscopic removal
  • people who have previously had open abdominal surgery

In open surgery, a single larger cut is made in the lower right-hand side of the abdomen to remove the appendix.

When there’s widespread infection of the inner lining of the abdomen (peritonitis), it’s sometimes necessary to operate through a cut along the middle of the abdomen. This procedure is called a laparotomy.

As with keyhole surgery, the incision is closed using either dissolvable stitches or regular stitches that need to be removed at a later date. 

After both types of surgery, the removed appendix is sent to a laboratory to check for signs of cancer.

This is a precautionary measure and it’s rare for a serious problem to be found.

Recovery

One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation.

If the procedure is carried out promptly, you may be able to go home within 24 hours.

With open or complicated surgery (for example, if you have peritonitis) it may take up to a week before you’re well enough to go home.

For the first few days after the operation it’s likely you’ll have some pain and bruising. This improves over time, but you can take painkillers if necessary.

If you have had keyhole surgery, you may have pain in the tip of your shoulder for about a week.

This is caused by the gas that was pumped into your abdomen during the operation.

You may also have constipation for a short period after the operation.

To help reduce this, do not take codeine painkillers, eat plenty of fibre, and drink plenty of fluids.

Your GP can prescribe medication if the problem is particularly troublesome.

Before leaving hospital, you’ll be advised about caring for your wound and what activities you should avoid.

You should be able to return to normal activities in a couple of weeks, although you may need to avoid more strenuous activities for 4 to 6 weeks after open surgery.

Your surgeon should discuss this with you.

When to get medical advice

While you recover, it’s important to keep an eye out for signs of any problems.

Contact your care team at the hospital or your GP if you:

  • have increased pain and swelling
  • start vomiting repeatedly
  • have a high temperature
  • have discharge coming from the wound
  • notice the wound is hot to touch

These symptoms could be a sign of infection.

Risks

Removal of the appendix is one of the most commonly performed operations in the UK, and serious or long-term complications are rare.

But like all types of surgery, there are some risks, including:

  • wound infection – although antibiotics may be given before, during or after the operation to minimise the risk of serious infections
  • bleeding under the skin that causes a firm swelling (haematoma) – this usually gets better on its own, but you should see your GP if you’re concerned
  • scarring – both types of surgery will leave some scarring where the incisions were made
  • a collection of pus (abscess) – in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery
  • hernia – at the site of the open incision or any of the incisions used in keyhole surgery

The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling stomach contents, leading to pneumonia.

But serious complications like this are very rare.

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