Appendicitis

Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10cm (2 to 4 inches) long, and it's connected to the large intestine, where stools (faeces) are formed.

Nobody knows exactly why we have an appendix, but removing it isn't harmful.

Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.

Pressing on this area, coughing or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally have diarrhoea.

If you have abdominal pain that keeps getting worse, contact your doctor or a local out-of-hours service straight away.

Phone 999 for an ambulance if the pain comes on suddenly, keeps getting worse and spreads across your abdomen. These are signs your appendix may have burst, which can lead to complications that could threaten your life.

Read more about:

• diagnosing appendicitis
• complications of appendicitis

In most cases of appendicitis, the appendix needs to be removed by surgery as soon as possible. The operation is called an appendectomy or appendicectomy. It is one of the most common operations, and its success rate is excellent.

Most often it's done as keyhole surgery (laparoscopy). The surgeon makes several small cuts in your abdomen and puts special surgical instruments in through them. Open surgery uses a single, larger cut in the abdomen. It's usually done if the appendix has burst or if it's harder to reach.

Most people make a full recovery from an appendectomy in a couple of weeks. After open surgery, though, you may need to avoid strenuous activities for up to 6 weeks.

Doctors don't know exactly what causes appendicitis. Most cases are thought to start when something blocks the entrance of the appendix.

A small piece of faeces can form a blockage, for example. Or an upper respiratory tract infection can make a lymph node swell within the wall of the bowel, and that can block it too.

The blockage leads to inflammation and swelling. The pressure from that swelling can then make the appendix burst.

Because the causes aren't fully understood, there's no guaranteed way of preventing appendicitis.

Appendicitis is a common condition. Around 1 in every 13 people are thought to get it at some point in their life.

It can happen at any age, but it's most common in young people aged from 10 to 20 years old.

Appendicitis usually begins with a pain in the middle of your tummy (abdomen). The pain may come and go at first.

Within a few hours, it moves to the lower right-hand side, which is where the appendix normally sits. By then the pain is constant and severe. Pressing on the area, coughing or walking can all make it worse.

With appendicitis, you may have other symptoms too, including:

• feeling sick (nausea)
• being sick
• loss of appetite
• diarrhoea
• a high temperature (fever) and a flushed face

If you have abdominal pain that keeps getting worse, contact your doctor or the 16263 health line straight away.

Appendicitis is easy to mistake for something else, such as:

• gastroenteritis
• severe irritable bowel syndrome (IBS)
• constipation
• bladder or urine infections
• Crohn's disease
• pelvic infection

In young women, these symptoms can sometimes have a gynaecological cause, such as an ectopic pregnancy or menstrual pain.

Whatever the cause, any condition that gives you constant stomach pain needs urgent medical attention.

Phone 999 for an ambulance if the pain suddenly gets worse and spreads across your abdomen. These are signs your appendix may have burst. When the appendix bursts, it can cause peritonitis, which is a potentially serious infection of the inner lining of the abdomen.

Appendicitis can be tricky to diagnose unless you have the typical symptoms, and only about half of all cases have them.

Some people's appendixes also sit in a slightly different part of the body, such as:

• the pelvis
• behind the large intestine
• around the small bowel
• near the right lower part of the liver

Other people get pain that feels like appendicitis but comes from something else, such as:

• gastroenteritis
• severe irritable bowel syndrome (IBS)
• constipation
• a bladder or urine infection

Your doctor will ask about your symptoms and examine your abdomen. They will also check whether the pain gets worse when they press on the appendix area (your lower right-hand side).

If your symptoms are typical of appendicitis, this is normally enough for the doctor to make a confident diagnosis. You'll then be sent to hospital for treatment straight away.

If your symptoms aren't typical, you may need further tests in hospital. These help confirm whether it's appendicitis and rule out other conditions.

The tests may include:

• a blood test to look for signs of infection
• a pregnancy test for women
• a urine test to rule out other conditions, such as a bladder infection
• an ultrasound scan to see if the appendix is swollen
• a computerised tomography (CT) scan

Test results can sometimes take a while to come back. If the diagnosis is still uncertain, your surgeon may recommend a laparoscopy, which lets them inspect your appendix and pelvic organs.

If appendicitis is suspected, you'll usually be advised to have your appendix removed, because the risk of it bursting is not worth taking. This means some people have their appendix taken out and it's later found to be normal.

Where the diagnosis isn't certain, a doctor may sometimes suggest waiting up to 24 hours to see whether your symptoms improve, stay the same or get worse.

If your doctor thinks your appendix has burst, you'll be sent to hospital immediately for treatment.

If you have appendicitis, your appendix usually needs to be taken out as soon as possible. The operation is called an appendectomy or appendicectomy.

Doctors usually recommend surgery too when there's a chance you have appendicitis but they can't make a clear diagnosis. The reason is simple. Removing the appendix is considered safer than running the risk of it bursting.

In humans, the appendix doesn't do any important job, so having it removed doesn't cause any long-term problems.

An appendectomy is done under general anaesthetic, using either a keyhole or an open technique.

Keyhole surgery (laparoscopy) is usually the preferred way to remove the appendix in appendicitis, because recovery tends to be quicker than with open surgery.

The surgeon makes 3 or 4 small cuts (incisions) in your tummy (abdomen). Special instruments are then put in through these cuts, including:

• a tube that gas is pumped through to inflate your abdomen, which lets the surgeon see your appendix more clearly and gives them more room to work
• a laparoscope, which is a small tube containing a light source and a camera, and it sends images of the inside of the abdomen to a television monitor
• small surgical tools used to remove the appendix

Once the appendix is out, the incisions are usually closed with dissolvable stitches. Regular stitches may be used as well, and these need to be removed by a doctor 7 to 10 days later.

Sometimes keyhole surgery isn't recommended for appendicitis, and the surgeon does open surgery instead. This usually happens in these situations:

• when the appendix has already burst and formed a lump called an appendix mass
• when the surgeon isn't very experienced in laparoscopic removal
• when a person has had open abdominal surgery before

In these cases, the surgeon makes a single larger cut in the lower right-hand side of your abdomen and removes the appendix through it.

If there's widespread peritonitis (infection of the inner lining of the abdomen), it's sometimes necessary to operate through a long cut along the middle of the abdomen. This procedure is called a laparotomy.

As with keyhole surgery, the cut is closed either with dissolvable stitches or with regular stitches that need to be removed later.

After both types of surgery, the appendix that has been taken out is routinely sent to a laboratory to check for any signs of cancer. This is a precaution, and it's rare for a serious problem to be found.

One of the big advantages of keyhole surgery for appendicitis is that recovery tends to be quick, and most people can leave hospital a few days after the operation.

If the appendix is operated on promptly, most patients can go home within 24 hours. With open or complicated surgery, for example if you have peritonitis, it may take up to a week before you're well enough to go home.

For the first few days after the operation, you're likely to have some pain and bruising. This gets better over time, and you can take painkillers if you need them.

If you had keyhole surgery, you may feel pain in the tip of your shoulder for about a week. The gas that was pumped into your abdomen during the operation causes it.

You may also get some short-term constipation. You can help reduce this by not taking codeine painkillers, eating plenty of fibre and drinking enough fluids. Your doctor can prescribe medicine if the problem is particularly troublesome.

Before you leave hospital, you'll be advised on how to care for your wound and which activities to avoid.

In most cases you can return to normal activities in a couple of weeks, although you may need to avoid more strenuous activities for 4 to 6 weeks after open surgery.

While you recover, keep an eye out for any signs of trouble. Contact the hospital unit where your appendectomy was done, or your doctor, if you notice:

• increasing pain and swelling
• you start vomiting repeatedly
• a high temperature (fever)
• any discharge coming from the wound
• the wound is hot to touch

These symptoms could be a sign of infection.

Appendectomy, the operation to remove an inflamed appendix, is one of the most commonly performed operations in the UK, and serious or long-term complications are rare. Still, like any surgery, it carries some risks. These include:

• antibiotics may be given before, during, or after the operation to lower the risk of serious infections
• bleeding under the skin that causes a firm swelling (haematoma), which usually gets better on its own, but you should see your doctor if you're concerned
• scarring, because both surgical techniques will leave some scarring where the cuts were made
• a collection of pus (abscess), which in rare cases can form after surgery when an infection has been caused by the appendix bursting
• hernia, at the site of the open incision or any of the incisions used in the laparoscopic approach

Using a general anaesthetic also carries some risks, such as an allergic reaction or inhaling stomach contents, which can lead to pneumonia. Serious complications like this are very rare.

Sometimes appendicitis leads to a lump forming on the appendix, which is called an appendix mass. The lump is made up of the appendix and fatty tissue. It's the body's own attempt to deal with the problem and heal itself.

If doctors find an appendix mass when they examine you, they may decide it isn't necessary to operate straight away. You'll be given a course of antibiotics instead, and an appointment will be made for an appendectomy a few weeks later, when the mass has settled.

Antibiotics have also been suggested as another possible alternative to immediate surgery for appendicitis. Studies have looked into whether they could replace surgery, but so far there isn't enough clear evidence to say that they can.

If you don't get treatment for appendicitis, your appendix can burst and cause infections that may threaten your life.

Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs your appendix may have burst.

If your appendix bursts, bacteria are released into other parts of your body. If that infection spreads to the peritoneum, the thin layer of tissue that lines the inside of the abdomen, it can cause a condition called peritonitis.

Symptoms of peritonitis can include:

• severe continuous abdominal pain
• feeling sick or being sick
• a high temperature (fever)
• a rapid heartbeat
• shortness of breath with rapid breathing
• swelling of the abdomen

If peritonitis isn't treated immediately, it can cause long-term problems and may even be fatal. Treatment usually involves antibiotics and the surgical removal of the appendix (appendectomy).

An abscess can sometimes form around a burst appendix. It's a painful collection of pus, and it happens because the body is trying to fight the infection.

An abscess can also appear as a complication of surgery to remove the appendix, in about 1 in 500 cases.

Antibiotics can sometimes treat an abscess, but in the vast majority of cases the pus has to be drained. Doctors can do this under ultrasound or computerised tomography (CT) guidance. They use a local anaesthetic, pass a needle through the skin, and then place a drain.

If an abscess is found during surgery, the area is washed out carefully and you are given a course of antibiotics.