Appendicitis is inflammation of the appendix, a small pouch on the gut wall at the start of the large intestine. It is a medical emergency as, left untreated, the appendix can burst or perforate.
Appendicitis is thought most often to be caused by blockage of the appendix ‘tube’ either by something stuck on the inside, or by swelling of the appendix wall. Blockage may be by trapped seeds, indigestible food remnants or hard stools (faeces) that get stuck in the appendix, or by lymph glands in the appendix wall which have swollen in response to infection elsewhere in the body.
If the appendix is inflamed and swollen, and cannot empty, then germs (bacteria) may thrive and cause inflammation in the wall and behind the blockage in the ‘dead end’ of the appendix.
Who gets appendicitis?
Appendicitis is common and can affect anyone of any age. Teenagers and young adults are the most commonly affected. Appendicitis can develop at any age but is most common between 10 and 20 years of age. It is very rare under the age of 2 years.
It is slightly more common in women than in men and is much more common in western countries. This is thought to be partly due to the western diet which is often low in fibre. It is rare in rural parts of the developing world.
What are the symptoms of appendicitis?
Typical symptoms of appendicitis are:
- pain, often starting as a dull ache around the tummy button, getting worse and more constant over several hours and moving to the lower right tummy
- feeling sick (nausea) or being sick (vomiting)
- loss of appetite
- high temperature (fever)
How is appendicitis diagnosed?
A doctor may diagnose appendicitis quite easily if you have the typical symptoms. However, not everyone has typical symptoms. There is no easy, fool proof test that can confirm appendicitis. A surgeon often has to make the final judgement about whether to operate, based on their assessment of you. It therefore depends on whether your symptoms, and the findings when you are examined, suggest that appendicitis is the probable diagnosis.
Some people develop pain that is similar to appendicitis but which is caused by other conditions. For example:
- Pelvic inflammatory disease
- Urinary tract infection (cystitis)
- Passing a kidney stone (ureteric colic)
- Inflammation of the large bowel (large intestine) – a condition called (colitis)
- Inflammation of the first part of the large bowel (the caecum) itself
- In women the right ovary lies near to the appendix, so pain in this area could come from either organ. A leaking ovarian cyst, or the normal pain of ovulation can mimic appendicitis
- Ectopic pregnancy
- In children swollen glands in the tummy around the bowel often associated with viral infections
- Occasionally pain from gallstones or from inflammation of the gallbladder can mimic appendicitis.
Treatment for appendicitis
The normal, established treatment of appendicitis is an operation to remove the inflamed appendix. The aim is to do this before it bursts (perforates), as a perforated appendix is a very serious condition.
There are usually no long-term complications after the operation. As with any operation, there is a small risk of complications from the operation itself (including bleeding and infection) and from the anaesthetic. You will usually be able to go home within 24 hours of uncomplicated surgery. You can expect some pain, and often constipation, but these should start to improve within a few days. You should be able to resume your normal activities a couple of weeks after surgery.
Studies have suggested that in some cases appendicitis can be treated with antibiotics alone, without the need for surgery. This removes the risks associated with surgery, and is successful in many simple cases. However, the appendicitis often returns (relapses) later, so this is not yet established or routine practice.
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