Appendicitis

Overview

Appendicitis is inflammation of the appendix, a small finger-like projection at the beginning of the large intestine. The appendix is located in the lower right abdomen, and its function is not fully understood today.

Appendicitis is the most common emergency surgical condition. Lifetime risk is 7%; it is most common between ages 10-30. Once diagnosed, the appendix can burst within 24-72 hours, leading to serious complications.

Symptoms

Classic symptoms:

• Pain starting around the navel and shifting to the lower right abdomen within 12-24 hours (McBurney's point)
• Nausea, vomiting
• Loss of appetite
• Mild fever (37.5-38.5 °C)
• Abdominal distension
• Pain worsened by movement, coughing, walking
• Inability to pass gas
• Constipation or diarrhea (sometimes)

Atypical cases:

• In children: vomiting, irritability more prominent
• In pregnant women: pain may shift to the upper right quadrant
• In the elderly: symptoms may be subtle, late diagnosis
• Retrocecal appendicitis: back pain
• Pelvic appendicitis: urinary symptoms, diarrhea

When the appendix bursts (perforation):

• Pain temporarily decreases (misleading!)
• Then generalized abdominal pain (peritonitis)
• High fever
• Abdominal rigidity
• Signs of shock

Causes

Blockage of the appendix:

• Hardened stool (fecalith)
• Lymph node swelling (especially in children)
• Parasite
• Foreign body
• Tumor (rare)

After blockage:

1. Fluid accumulates inside the appendix
2. Bacteria multiply
3. Inflammation, swelling
4. Decreased blood flow
5. Tissue death and perforation

Risk Factors

• Ages 10-30
• Being male (slightly more common)
• Family history
• Cystic fibrosis (in children)

Complications

• Perforation (rupture): Bursting of the appendix — most serious complication
• Peritonitis: Inflammation of the abdominal lining (life-threatening)
• Appendicular abscess: Pus collection
• Sepsis: Bloodstream infection
• Adhesions
• Bowel obstruction
• Post-surgical complications: Wound infection, hematoma

When to See a Doctor

Emergency (call emergency services or go to the nearest ER):

• Severe, lower right abdominal pain
• Pain shifting from around the navel to the lower right abdomen
• Pain accompanied by nausea, vomiting, fever
• Abdominal pain worsened by movement
• Abdominal pain lasting more than 6 hours
• Protecting the abdominal area when walking, bending
• Abdominal rigidity
• Right-sided pain during pregnancy

Do not wait: Appendicitis becomes harder to diagnose over time; delay increases the risk of perforation.

Diagnosis and Treatment

Diagnosis:

• Physical examination (tenderness at McBurney's point, guarding, rebound)
• Rovsing, psoas, obturator signs
• Blood tests: Elevated white blood cell count (leukocytosis), elevated CRP
• Urinalysis (for differential diagnosis)
• Imaging:
  • CT (most sensitive): Appendix diameter >6 mm, inflammation
  • Ultrasound: Especially in children and pregnant women
  • MRI (alternative in pregnancy)
• Alvarado score: Clinical decision support

Treatment:

1. Surgery (appendectomy - main treatment):

• Laparoscopic appendectomy (preferred):
  • 3 small incisions
  • Faster recovery
  • Less pain
  • 1-2 days hospital stay
• Open appendectomy:
  • In case of perforation, abscess
  • 3-5 cm right lower abdomen incision
  • 3-5 days hospital stay

2. Complicated appendicitis (perforation, abscess):

• Intravenous antibiotics
• Percutaneous drainage (for abscess)
• Sometimes delayed surgery (interval appendectomy)

3. Antibiotic therapy (selected patients):

• As an alternative in uncomplicated appendicitis
• 70% success; however, there is a risk of recurrence
• Surgery is usually preferred

Post-surgical:

• Early mobilization
• Soft diet, then normal
• Return to normal within 1-2 weeks
• Sports, heavy lifting after 4-6 weeks

Prevention

There is no definitive way to prevent appendicitis; however, some factors may reduce the risk:

• High-fiber diet (vegetables, fruits, whole grains)
• Adequate water intake
• Regular bowel movement
• Maintain a healthy weight

Most importantly: When symptoms of appendicitis appear, quick diagnosis and treatment prevent complications. Take abdominal pain seriously; do not ignore right lower abdominal pain.