Appendicitis: symptoms, tests and surgery explained, a review

Appendicitis is a common cause of sudden belly pain and it needs urgent medical care. This article explains what the appendix is, what the warning signs look like, how doctors find out whether it is appendicitis and what treatment and recovery usually involve. It draws on information from the NHS, MedlinePlus and the US National Institute of Diabetes and Digestive and Kidney Diseases.

1. Introduction

The appendix is a small, tube-like pouch joined to the first part of the large bowel, in the lower right side of the abdomen (the belly) ^{[1, 2]}. Appendicitis means that the appendix has become swollen and inflamed, often with infection ^[1]. MedlinePlus states that the appendix has no known function ^[2], and the NHS says removing it is not harmful ^[1].

Anyone can get appendicitis, but it is most common in children over 10 and in young adults, and MedlinePlus gives the age range of 10 to 30 ^{[1, 2]}. It is rare in babies under 12 months ^[1]. NIDDK describes it as the most common cause of sudden belly pain that needs surgery ^[3].

2. Causes

The usual story is a blockage. The NHS explains that swelling and infection often follow a blockage of the appendix by undigested food or hard stool (poo) ^[1]. MedlinePlus adds that a blockage raises pressure inside the appendix, reduces its blood flow and triggers inflammation ^[2]. Sources do not describe a way to prevent it.

3. Signs and symptoms

The classic pattern, as described by the NHS, is pain that starts around the belly button and, within a few hours, moves to the lower right side of the abdomen and becomes worse ^[1]. The pain may get worse when you move, cough or press on the area, and pulling the knees up towards the chest may ease it slightly ^[1].

Other symptoms listed by the sources include ^{[1, 2, 3]}:

• Loss of appetite
• Feeling sick or being sick
• A fever (MedlinePlus says a low fever)
• Constipation or diarrhoea
• Swelling of the belly
• Being unable to pass wind

Not everybody has every symptom ^[2]. The NHS notes that symptoms can be different, slower to develop or in another place, and this is more likely in pregnant women, young children and older people. In older people, sudden confusion can be a sign ^[1].

If the appendix bursts, the pain may ease for a short time and then become severe and spread across the whole belly ^[1].

4. Diagnosis and tests

No single test always proves appendicitis, and other problems can feel similar, including urine infections, kidney stones, gallstones, bowel conditions and problems with the ovaries or womb ^[1]. For this reason the NHS advises against trying to diagnose yourself ^[1].

A doctor will first examine your belly and ask about your symptoms and health history ^{[1, 3]}. In hospital, tests may include ^{[1, 3]}:

• Blood tests
• A urine sample
• A pregnancy test, if pregnancy is possible
• Imaging, such as an ultrasound scan, a CT scan (a detailed X-ray scan) or an MRI scan, to look at the appendix and to find other causes of the pain

The NHS says doctors may watch you in hospital for a few hours to see how symptoms change, and that surgery may be advised without more tests if appendicitis is very likely or the appendix may have burst ^[1].

5. Treatment

MedlinePlus calls appendicitis a medical emergency, and treatment almost always involves an operation to remove the appendix, called an appendectomy ^[2]. NIDDK says that prompt surgery lowers the risk of the appendix bursting ^[3].

The NHS describes the operation like this ^[1]:

1. You are given a general anaesthetic, so you are asleep and feel no pain.
2. The surgeon usually works through a few small cuts using a thin camera (keyhole or laparoscopic surgery). A larger cut in the lower right belly (open surgery) is used if needed.
3. The appendix is cut away where it joins the bowel, and the area is cleaned if the appendix has burst.
4. The cuts are closed with stitches, clips or glue.

The operation usually takes about an hour ^[1]. NIDDK notes that some mild cases may be treated with antibiotics alone ^[3]. The NHS says antibiotics alone may be an option when infection has not spread and surgery would be high risk ^[1]. If a lump has formed around the appendix, doctors usually give antibiotics first and may operate some weeks later if symptoms continue ^[1]. Your surgical team decides which approach is right for you.

6. Recovery and possible problems

The NHS says most people recover within 1 to 2 weeks, and recovery can take longer if the appendix burst ^[1]. After keyhole surgery some people go home the next day, while open surgery or complications can mean several days in hospital ^[1]. You can go home once you are eating, drinking and passing stool ^[1].

At home, the NHS advises to follow your wound-care instructions, finish any antibiotics you are given, avoid strenuous activity such as sport until you have fully recovered and not to drive until you could safely make an emergency stop ^[1]. Constipation can be eased with fibre and plenty of fluids, and a pharmacist can advise about gentle laxatives ^[1].

Problems after the operation are uncommon. They include wound infection, bleeding, scar tissue called adhesions that can rarely block the bowel, a collection of pus called an abscess and, rarely, infection in the small piece of appendix left behind ^[1]. If the appendix bursts, the infection can spread to the lining of the belly (peritonitis) or the blood (sepsis) ^{[1, 2]}.

7. When to see a doctor

The NHS advises an urgent GP appointment or a call to NHS 111 (in the UK) if belly pain keeps getting worse, does not go away or moves to the lower right side ^[1]. Go to hospital urgently if the pain is severe, or if there is confusion, blotchy or paler skin, or difficulty breathing, which can be signs of sepsis ^[1]. Do not drive yourself, and bring a list of your medicines ^[1]. After an operation, seek advice if the wound becomes more sore or red, bleeds or leaks pus, or you develop a high temperature ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Appendicitis is common, can be hard to tell from other causes of belly pain and needs prompt medical care. The most useful steps are to recognise pain that moves to the lower right belly, to seek help early and to follow your surgical team's advice on treatment and recovery.