Appendicitis

Appendicitis is brought on when the appendix becomes inflamed and swollen. The appendix is a tiny, pouch-like organ found in the right hand side of the abdomen. The appendix is not a vital organ, in fact it has no real function in the body, however, appendicitis can be very serious and potentially deadly, so it is important that it is treated as quickly as possible. In most cases the first sign of appendicitis is a pain in the middle of the abdomen which spreads to the lower right hand side.

Appendicitis is a common condition which can affect people of all ages but it tends to be more common among people aged between 10 and 20 years old. It is estimated that around 7 in 100 people will develop appendicitis at some point in their lives.

What causes appendicitis?

The source of appendicitis is unknown in many cases; however, it is believed that blockages within the appendix (called the lumen) may be a cause. It is thought that small pieces of faeces may become trapped in the appendix, since the organ is attached to the large intestine. Once faeces are trapped bacteria start to multiply and this can cause the appendix to become inflamed and pus to collect.

Another possible cause of appendicitis may be an infection in the stomach, which has then spread to the appendix.

Symptoms of appendicitis

Symptoms of appendicitis usually start with abdominal pain in the middle of the tummy, which may come and go, gradually gets worse and radiates to the lower right hand side of the abdomen where the appendix is based. Most people’s symptoms get worse after around 6 hours. Pain often becomes severe and may get worse if you make a sudden movement, touch the area around the appendix or cough. Some people find that pulling their knees towards their chest helps to ease the pain.

Other symptoms associated with appendicitis include:

• Nausea.
• Vomiting.
• Passing urine more frequently.
• Loss of appetite.
• Fever (high temperature).
• Diarrhoea.
• Constipation.

The symptoms of appendicitis are often fairly general and it may be tempting to ignore them and hope that they get better alone. But if you suffer from abdominal pain it is important to see your doctor, especially if the pain is getting worse.

When should I see a doctor?

If you suffer from abdominal pain you should see your GP. If the pain is getting worse and spreads to the lower right hand side of the abdomen you should call 999. If the appendix bursts bacteria is released into the body, which can cause fatal infections, so it is important that you get treatment as quickly as possible to prevent this from happening.

How is appendicitis diagnosed?

Many of the symptoms of appendicitis are associated with other conditions so it can be difficult to diagnose. However, if you are experiencing abdominal pain and your doctor suspects that you have appendicitis, they will have to make a decision quickly about whether or not to operate as the appendix can rupture and cause life-threatening infections. Often, appendicitis can be diagnosed based on the type of pain experienced in the abdomen and a feeling of tenderness surrounding the appendix. Tests can be carried out but the results can take a while to come back, so your surgeon may advise you to have the appendix out rather than run the risk of it rupturing. The appendix has no apparent function in the body so your health and day-to-day life will not be impaired by having it removed.

In some cases the symptoms are not typical and this may mean that doctors need to run tests (these may include a CT scan, ultrasound scan and X-rays) to confirm a diagnosis. They will then weigh up the benefits and risks of waiting for the results and may decide to operate if they think it is in your best interests.

Appendicitis can be particularly difficult to diagnose in young children, pregnant women and the elderly as their symptoms tend to be atypical.

Treatment for appendicitis

If a doctor or paramedics suspect that you have appendicitis you will be taken to hospital. If a diagnosis of appendicitis is made surgeons usually act quickly to take out the appendix. If the appendix is not removed and it ruptures this can cause harmful bacteria to be released, which can cause life-threatening infections. The priority in the vast majority of cases is to remove the appendix to avoid it bursting.

The operation to remove the appendix (identified as an appendectomy) is usually done via keyhole surgery. The procedure is one of the most commonly performed operations in the UK and has a very high success rate. Three small incisions are made around the appendix and the organ is removed. Keyhole surgery is preferable because it carries fewer risks, facilitates healing and reduces the risk of scarring.

In some cases keyhole surgery may not be advised and open surgery may be carried out instead. This may be the case for individuals who have tumours in the digestive system, patients who have a burst appendix, pregnant women (during the first 12 weeks) and patients who have had stomach surgery previously.

If you have had keyhole surgery to get rid of the appendix you will probably be free to leave after around 3-4 days, although it may take a couple of weeks to make a full recovery. If you have had open surgery recovery time is longer and you may need to spend at least one week in hospital.

Complications of appendicitis

Appendicitis is a serious condition which should always be treated as a medical emergency. If you experience symptoms of appendicitis you should seek urgent medical help. In most cases surgery can be performed to get rid of the appendix before it bursts and most people make a full recovery. However, if appendicitis is left untreated the appendix can rupture, causing bacteria and pus to leak into other parts of the body. Possible complications of appendicitis include:

• Peritonitis: this is an infection which causes the abdomen to become swollen and painful and prevents normal bowel movements. Symptoms of peritonitis include fever, severe abdominal pain and a racing heartbeat. Peritonitis can be very serious if it is not treated quickly and may even be fatal.
• Abscess: an abscess can form around the appendix if it ruptures and can cause pain. Abscesses can usually be treated very effectively with antibiotics (in some cases the abscess may need to be drained first).