Appendicitis is inflammation of the appendix, a small pouch attached to the caecum, a part of the large intestine located in the lower right side of the abdomen. It is approximately the size of a finger. The precise function of the appendix in the human body is as yet unknown, although it has been found to play a role in digestion for other animal species.
This condition is a medical emergency. If the appendix bursts, its infected contents will spread throughout the abdominal cavity. Infection of the lining of the abdominal cavity (peritonitis) can be life threatening without prompt treatment.
Anyone of any age can develop appendicitis, but it is more common during childhood and adolescence. It is less common but may still present in patients over the age of 30 years.
- Dull pain centred around the navel, which progresses to a sharp pain in the lower right side of the abdomen.
- Rebound tenderness – the pain increases when pressure on the abdomen is released
- Low grade fever
- Nausea and vomiting
- Diarrhoea or constipation
- Loss of appetite.
The cause of appendicitis is unclear, however, obstruction of the appendix cavity by food or faecal material may be a precipitating factor in the development of the condition. There is no direct evidence that diet plays a role in causing appendicitis.
Many people treated for acute appendicitis may have had previous episodes of low grade or sub-clinical appendicitis that they overcame without medical intervention.
Appendicitis can be hard to diagnose in the early stages as the symptoms often mimic those of other disorders such as gastroenteritis, ectopic pregnancy and other infections of the kidneys or chest. Diagnosis therefore will include:
- A patient history of the onset, type and severity of symptoms
- A thorough physical examination which may include a rectal examination
- Blood tests to check for a raised white cell count to indicate infection
- Urine tests to exclude urinary tract infections or kidney stones
- Imaging tests such as abdominal X-Ray, ultrasound or Computerised Tomography (CT) scan may be ordered if diagnosis is uncertain.
In some cases of mild appendicitis or where the diagnosis is uncertain, admission to hospital for observation and antibiotic therapy may be the suggested course of treatment.
Surgery, however, is indicated if the condition fails to settle spontaneously or the risk of rupture is imminent. This procedure, which aims to remove the appendix completely, is known as an appendicectomy. Your doctor will perform the surgery under general anaesthesia. Antibiotics are often given before surgery to reduce the risk of infection.
There are two operative techniques for appendicetomy – Open appendicetomy and Laparoscopic appendicetomy.
The technique for removal of the inflamed appendix will depend on your surgeons’ preference and whether the appendix has ruptured.
A small incision is made on the right side of the lower abdomen, the appendix is visualised, cut away, removed and the wound on the large intestine is sealed. The abdominal wound is closed with sutures or staples. If a rupture has occurred, the peritoneal cavity will be thoroughly irrigated with sterile saline solution to remove any pus. In this situation the surgeon will insert a tube and drain the abdominal cavity of pus. Intravenous antibiotics are given to the patient to reduce the possibility of peritonitis.
The typical hospital stay for an uncomplicated open appendicectomy is between 1 and 2 days.
The appendix can often be removed using laparoscopic (keyhole) surgery. The surgeon will use a slender instrument (laparoscope), which is inserted through tiny incisions (cuts) in the abdomen. This eliminates the need for an abdominal incision.
Removing the appendix appears to have no effect on the workings of the digestive system, in either the short or long term.
Please refer to the Laparoscopic Surgery “For Patients” page on the website for more information about the laparoscopic management of this condition.