Appendicitis: Causes, Symptoms, Diagnosis and Treatment

Article medically reviewed by Dr. Steven T. Elsbecker, DO.

Have you heard the story about how Houdini, the great illusionist, died? Rumor has it that after he was punched in the abdomen, his appendix ruptured which caused widespread severe infection (sepsis) and death.

Although he did die from sepsis after rupturing his appendix, it had no connection with him being punched in the abdomen. It was more likely due to a lack of appropriate medical care and effective antibiotics at that time.

It is likely you must have previously heard of someone in your family or friend circle getting treated for appendicitis, given how common it is. There are approximately 300,000 hospital visits related to appendicitis in the United States each year.

Appendicitis is also the most common cause of abdominal pain requiring surgery in the United States.

If you have ever wondered what appendicitis is, or what causes it, or how it is treated, we are here to answer those questions for you.

This comprehensive article covers all the essential information about appendicitis you need to know.

What is the Appendix and Where is it Located?

The appendix is a small finger-like tissue extension on the right side of your large intestine. It is normally found in the lower right abdomen, although it can sometimes be found in a slightly different location such as in pregnant women when the enlarged uterus pushes the appendix out of position.

The appendix may be found behind the colon, or behind the liver and sometimes in the pelvis.

In children, the appendix serves as part of the immune system helping them fight infections. In adults, the appendix loses that function as it is handled by other parts of the body.

Although for a long time the appendix was thought to have no apparent function in adults, experts now believe that it serves as a safe house for good bacteria. Following an illness affecting the intestine, these good bacteria can help repopulate the intestines, allowing them to “reboot.”

Some in the medical community believe that the appendix is a remnant of embryological development and has no real function. Regardless, people can live just fine without the appendix, such as when it is removed through a surgery called “appendectomy.”

What is Appendicitis?

Appendicitis: Causes, Symptoms, Diagnosis and Treatment

Appendicitis is the inflammation of the Appendix. It occurs when the appendix gets inflamed. Although most often it is an “acute”, or short-term condition, it can sometimes be “chronic”, meaning it can last longer.

Appendicitis most commonly occurs between the ages of 5 and 45, with an average age of 28. Men have a slightly higher risk of developing acute appendicitis than women.

What Causes Appendicitis?

Appendicitis can occur if the appendix is blocked, either by hardened stool, tumors, intestinal parasites, or by an infection that causes the appendix to swell up.

Appendicitis can also be caused by traumatic injuries such as stab wounds, gunshot wounds, and road traffic accidents.

The swelling of the tissue can then cause obstruction in blood supply to the appendix, causing a shortage of oxygen and nutrients, leading to the death of the tissue of the appendix. This can encourage the growth of bacteria and cause infection.

Symptoms of Appendicitis

The most common symptom of appendicitis is belly pain. This pain can be in the right lower abdomen, or it may start around the belly button and then move to the right lower abdomen. If the appendix bursts, the pain may be felt all over the abdomen.

Other common symptoms of appendicitis are fever, vomiting, and nausea. Some people may also feel “anorexia”, which means a loss of appetite. Diarrhea or constipation can also be a symptom of appendicitis.
As you can see, most of the symptoms of appendicitis are general and appendicitis can be sometimes misdiagnosed as another medical condition with similar symptoms.

How is Appendicitis Diagnosed?

Diagnosing appendicitis may sometimes be tricky, as many different illnesses can cause similar symptoms. The healthcare provider begins with a series of questions to the patient to understand the nature, onset, timing, and character of the pain better.

They may also ask questions that may give clues about the underlying cause of the patient’s symptoms. They may conduct a physical examination, including examining the belly and the patient’s general condition.

Although appendicitis is traditionally considered a clinical diagnosis, meaning the diagnosis can be reached through a clinical evaluation which includes taking a history and physical examination, several different diagnostic tests may be ordered to confirm a diagnosis of appendicitis. These include:

  • A CBC or Complete Blood Count: This may show an increased number of WBCs, or white blood cells, indicating a potential infection. Up to one-third of patients with appendicitis may have a normal WBC count.
  • A CT scan of the abdomen: This may help visualize the appendix to look for signs of inflammation or rupture.
  • An ultrasound scan of the appendix: Just like the CT scan, it helps visualize the appendix. Although it is less sensitive and less specific than a CT scan, an ultrasound is mainly preferred when there is a need to avoid exposure to the radiation a CT scan emits, for example in pregnant women and children.
  • A urine test: This will help rule out other diagnosis such as a urinary tract infection or UTI, or kidney stones.
  • A pregnancy test may be ordered to rule out possible ectopic pregnancy in female patients.

Appendicitis Treatment Options

If a patient with appendicitis comes to an emergency room or urgent care center, they will first be connected to fluids for appropriate hydration. Dehydration in patients with appendicitis can be caused due to vomiting, or aversion to eating and drinking from nausea and pain they might be feeling.

They will also be given pain medicine to relieve any belly pain they may be having, or to control their nausea and vomiting. They may also be kept fasting in preparation for surgery if one is needed.

Appendicitis is considered a surgical emergency and will likely be treated with an emergency surgery called “appendectomy,” meaning the removal of the appendix. With advancements in surgical techniques that are “minimally-invasive”, which means they only require minimal cutting and opening of the skin, laparoscopic appendectomies have become common.

During the procedure, the surgeon inserts the surgical equipment through small incisions in the abdomen. The appendix is cut and removed through the incision. The advantages of laparoscopic appendectomy include less pain, quicker recovery, and lesser cosmetic impact.

An “open” appendectomy may be needed in case of a “complicated appendicitis,” such as when there is an abscess or if the appendix has ruptured.

The surgery may sometimes be delayed for a few weeks. This is especially done when the appendix has ruptured, or if symptoms have lasted for more than 5 days. This allows the inflammation to reduce, making conducting the surgery more convenient and less risky for the patient. Antibiotics may also be given to the patient before surgery to reduce the risk of new infections.

Some medical experts believe that antibiotics could be an effective treatment alternative to surgery in patients with uncomplicated, acute appendicitis. However, some others maintain the stance that surgery is still a more effective treatment option for appendicitis.

Complication of Appendicitis Surgery

Some of the complications of an appendectomy are postoperative hematoma (collection of blood), abscess (collection of pus), and wound infections. Most often these complications can be avoided with appropriate surgical care and wound cleaning when required.

Patients who undergo a laparoscopic appendectomy can usually go home after a day of hospital stay. For the first few days, there may be some pain and constipation, for which patients are usually given pain killers and laxatives to soften their stool, reducing the need to strain when on the toilet.

After the surgery, if a person notices worsening pain or swelling, fever, a pus-like or bloody discharge from the site of the surgery, they should immediately contact their healthcare provider. It could be something that requires urgent medical attention.

Risks and Complications of Untreated Appendicitis

If appendicitis is left untreated, there is a risk of developing widespread severe infection and an abscess.

The inflamed appendix may perforate or burst, spilling infectious material into the abdomen causing “peritonitis”, which is the inflammation of the abdominal lining.

The perforation may also cause severe bleeding requiring blood transfusions. These complications can significantly worsen a patient’s condition and could ultimately lead to death.

Should you go to the emergency room for Appendicitis Treatment?

Appendicitis is considered a medical emergency and if you suspect you might be having appendicitis due to your symptoms, you must immediately go to an emergency room. Even if it is not appendicitis, it could be something dangerous that requires immediate treatment.

———————————————————————————————————–
Dr. Steven Elsbecker, DO, FACEP, SignatureCare Emergency Center ER PhysicianArticle medically reviewed by Dr. Steven Elsbecker, DO, FACEP. Dr. Elsbecker is the Greater Texas Regional Medical Director at SignatureCare Emergency Center. He graduated from the Arizona College of Osteopathic Medicine of Midwestern University in 2010. Dr. Elsbecker is board-certified in emergency medicine and works at the South Austin, TX SignatureCare Emergency Center in Austin, TX.