Appendicitis
Appendicitis is an inflammation of the appendix. The appendix is a finger-shaped pouch that sticks out from the colon on the lower right side of the belly, also called the abdomen.
Appendicitis causes pain in the lower right part of the belly. However, in most people, pain begins around the belly button and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes serious.
Although anyone can develop appendicitis, most often it happens in people between the ages of 10 and 30. Treatment of appendicitis is usually antibiotics and, in most instances, surgery to remove the appendix.
Symptoms of appendicitis may include:
- Sudden pain that begins on the right side of the lower belly.
- Sudden pain that begins around the belly button and often shifts to the lower right belly.
- Pain that worsens with coughing, walking or making other jarring movements.
- Nausea and vomiting.
- Loss of appetite.
- Low-grade fever that may rise as the illness worsens.
- Constipation or diarrhea.
- Belly bloating.
- Gas.
The site of the pain may vary, depending on age and the position of the appendix. In pregnancy, the pain may seem to come from the upper belly because the appendix is higher during pregnancy.
When to see a doctor
Make an appointment with a healthcare professional if you or your child has symptoms. Terrible belly pain requires immediate medical attention.
A blockage in the lining of the appendix, called the lumen, is the likely cause of appendicitis. This blockage can cause an infection. The bacteria then multiply quickly, causing the appendix to become inflamed, swollen and filled with pus. If not treated right away, the appendix may burst or break open.
Risk factors for appendicitis include:
- Age. Anyone can develop appendicitis, but it most often happens in people between the ages of 10 and 30.
- Your sex. Men have a slightly higher risk of appendicitis than do women.
Appendicitis may cause serious complications, such as:
- A burst appendix. A burst appendix, also called ruptured appendix, spreads infection throughout the abdomen, a condition called peritonitis. Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean the abdominal cavity.
A pocket of pus that forms in the abdomen. If the appendix bursts, a pocket of infection may develop. This is called an abscess. In most cases, a surgeon drains the abscess by placing a tube through the abdominal wall into the abscess. The tube is left in place for about two weeks, and antibiotics are prescribed to clear the infection.
Once the infection is clear, the appendix can be removed surgically. In some people, the abscess is drained, and the appendix is removed immediately.
To help diagnose appendicitis, a healthcare professional will likely take a history of symptoms and examine the abdomen.
Tests used to diagnose appendicitis include:
Physical exam. A healthcare professional may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse. This is because of inflammation of the lining of the abdominal cavity, called the peritoneum.
A care professional also may look for abdominal stiffness and a tendency to flex the abdominal muscles in response to pressure over the inflamed appendix. This is called guarding.
A care professional also may use a lubricated, gloved finger to examine the lower rectum. This is called a digital rectal exam. People of childbearing age may be given a pelvic exam to check for other problems that could be causing the pain.
- Blood test. This test checks for a high white blood cell count. A high white blood cell count may mean there’s an infection.
- Urine test. A urine test, also called a urinalysis, may be done. A urinalysis makes sure that a urinary tract infection or a kidney stone isn’t causing the pain.
- Imaging tests. Imaging tests may help confirm appendicitis or find other causes for pain. These tests may include an abdominal X-ray, an abdominal ultrasound, a CT scan or an MRI.
Appendicitis treatment usually involves surgery to remove the appendix. Before surgery, antibiotics to treat infection may be given.
Surgery to remove the appendix
Appendectomy is a surgery to remove the appendix. Appendectomy can be performed as open surgery using one abdominal cut about 2 to 4 inches long. This is called laparotomy. The surgery also can be done through a few small abdominal cuts. This is called laparoscopic surgery. During a laparoscopic appendectomy, the surgeon places special tools and a video camera into your abdomen to remove your appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.
But laparoscopic surgery isn’t right for everyone. You may need an open appendectomy if your appendix has ruptured and infection has spread beyond the appendix, or you have an abscess. An open appendectomy allows your surgeon to clean the abdominal cavity.
Expect to spend 1 to 2 days in the hospital after your appendectomy.
Draining an abscess before appendix surgery
If your appendix has burst and an abscess has formed around it, the abscess may be drained. To drain it, a tube is placed through your skin into the abscess. Appendectomy can be performed several weeks later, after the infection is under control.
If your appendicitis isn’t serious and doesn’t require surgery, antibiotics may be used alone. However, if the appendix isn’t removed, there is a higher chance of appendicitis coming back.
References
- Appendicitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis. Accessed April 5, 2023.
- Appendectomy: Surgical removal of the appendix. American College of Surgeons. https://www.facs.org/education/patient-education/patient-resources/operations. Accessed April 5, 2023.
- Martin RF. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. https://www.uptodate.com/contents/search. Accessed April 5, 2023.
- Smink D, et al. Management of acute appendicitis in adults. https://www.uptodate.com/contents/search. Accessed April 5, 2023.
- Medical review (expert opinion). Mayo Clinic. June 25, 2024.
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