By Dr. Cynthia Paciulli of Atlantic Surgical Associates

The appendix is a small, tube-like vestigial organ that hangs from the large intestine, typically located in the right lower abdominal cavity.  A vestigial organ is one which is considered to have become functionless over the course of evolution.  Although it may have an immune-related function, people can live a perfectly normal life without it. Appendicitis is inflammation of the appendix which, if left untreated, can progress to rupture, peritonitis, and death.

One theory of the cause of appendicitis is that the opening of this tube like organ into the large intesting becomes blocked by firm stool (fecalith).  Meanwhile, the normal intestinal bacteria will multiply in the closed space and the lining of the appendix continues to produce mucus which builds pressure.  Pressure and infection cause inflammation and severe localized pain and tenderness.  The wall of the appendix can then break open, spilling the toxic contents into the abdominal cavity, causing diffuse pain and infection.   This is called peritonitis, and it can be fatal.  This does not explain all cases of appendicitis, and the cause in those situations is unknown. 

Appendicitis is more common in men and teenagers, and family history seems to play a role in increased risk of developing the condition. Symptoms usually emerge quickly with pain increasing over a period of 6-12 hours, and may be different in infants, children, pregnant women, and the elderly.

Patients may have some or all of the following pain symptoms:

  • Discomfort around the belly button, moving to the right side of the abdomen over several hours
  • May be in a different location if the appendix is not in the usual place
  • Increases as inflammation and infection in the appendix builds
  • Worsens with sneezing, coughing, and deep breathing
  • May increase with movement

Patients may also experience:

  • Loss of appetite
  • Nausea and vomiting
  • Abdominal swelling
  • Abdomen feels hard and is sensitive to touch
  • Constipation
  • Mild diarrhea
  • Slight fever

If the appendix ruptures, symptoms include:

  • Pain becoming stronger and spreading across the abdomen
  • Increasing fever

If you have severe pain in the abdomen, get medical help right away, as appendicitis can be hard to diagnose. Symptoms vary and can be similar to symptoms of other diseases, so your provider will want to do a full exam and get a detailed medical history. The exam may include:

  • A careful examination of the abdomen
  • Blood and urine tests
  • Ultrasound
  • Computed tomography (CT) scan
  • Surgery (Laparoscopic or Open)

Appendicitis is usually treated treated by surgically removing the appendix as soon as possible (appendectomy). Because sometimes the diagnosis is not certain, the patient’s condition may be carefully monitored for 6-24 hours before operating, and patients may also be given antibiotics to fight infection. Studies are ongoing to determine whether some episodes of appendicitis can be successfully treated by antibiotics alone. 

Problems and complications from the surgical procedure are rare, but all procedures have some risk. Your doctor will review potential problems like bleeding, infection, other organ damage, and reactions to anesthesia. Complications are more common in unhealthy individuals but increase with rupture.  General surgical risk factors include smoking, obesity, diabetes, chronic lung or heart disease, and pregnancy.

Description of the Procedure

The majority of appendectomies are performed laparoscopically with small incisions and a camera, resulting in less pain and quicker recovery time. The procedure normally takes between 30 minutes to 1 hour, although in infrequent cases, it can take longer and require conversion to an open procedure. As a result of these advanced techniques, most  patients can go home in less than 24 hours.

If the appendix has ruptured, a warm water solution mixed with antibiotics will be used to wash out the inside of the abdomen. A catheter will then be placed to drain any fluid that builds up. Sometimes with severe infection at the time of an open procedure, the surgeon will only close the muscle layers and leave the skin open. The open skin wound would then be packed with a moist gauze dressing.

After the Procedure

Right after the procedure, the patient will be in a recovery room where blood pressure, pulse, and breathing will be monitored. Recovery may also include pain medications, antibiotics to prevent infection, medication to prevent blood clots, and resuming movement within 24 hours of surgery. If the appendix ruptured, drainage tubes are usually  removed within a few days.  The removed tissue will be examined by a pathologist.

After Hospital Discharge

Recovery time for the procedure is generally 5-7 days. Patients will be advised to slowly increase activities as approved by their provider, and to avoid exercise or heavy lifting immediately post-surgery. Following the provider’s instruction is of paramount importance to healing quickly and effectively.

There are no guidelines to prevent appendicitis. It starts quickly and the cause is usually unknown. Get medical care right away for any severe abdominal pain.