Appendicitis

Overview

What is appendicitis?

Your appendix is a finger-sized tube located where the large and small intestines connect. It has no known function, but if it gets inflamed or infected (appendicitis), you’ll need immediate treatment.

An inflamed appendix may cause pain off and on. Or it may burst open (rupture), causing sudden, severe pain. A ruptured appendix can spread bacteria through the abdominal cavity. These bacteria trigger a serious, sometimes-fatal infection called peritonitis.

Where is your appendix?

The appendix is in the lower right side of the abdomen (belly).

How common is appendicitis?

Approximately 5% of Americans will develop appendicitis. It’s the No. 1 cause of abdominal pain requiring surgery .

Who might get appendicitis?

Appendicitis can occur at any age, although it’s most common in people in their teens and 20s. Appendicitis in children most often occurs during the tween or teen years. But even elementary school-age children get appendicitis.

Symptoms and Causes

What causes appendicitis?

It’s not clear what brings on appendicitis. Something triggers an inflammation (irritation and swelling) or infection in your appendix. Causes could include:

What are the symptoms of appendicitis?

Severe abdominal pain in the lower right belly — where your appendix is — is a key sign of appendicitis. Symptoms often come on suddenly and get worse. They include:

  • Abdominal pain or tenderness that hurts more when you cough, sneeze, inhale or move.
  • Swollen belly.
  • Constipation.
  • Diarrhea.
  • Inability to pass gas.
  • Loss of appetite (not feeling hungry when you usually would).
  • Low-grade fever (below 100 degrees F).
  • Nausea and vomiting.

Diagnosis and Tests

How is appendicitis diagnosed?

You’ll describe your symptoms and have a physical exam. Your doctor may order a blood test to check for infection. You also may have an imaging scan. Any of these tests can show signs of blockage, inflammation or organ rupture:

Management and Treatment

How is appendicitis treated?

Most people with appendicitis need a surgery called an appendectomy. It removes a diseased appendix. If the appendix hasn’t yet ruptured, surgery prevents that rupture and keeps infection from spreading.

Before surgery, you receive intravenous (IV) antibiotics to treat infection. Some cases of mild appendicitis get better with antibiotics alone. Your doctor will watch you closely to determine if you need surgery. Surgery is the only way to treat abdominal infection when the appendix ruptures.

If you need surgery, most appendectomies are done laparoscopically. Laparoscopic procedures take place with a scope through small incisions. This minimally invasive approach helps you heal faster, with less pain. You may need major abdominal surgery (laparotomy) if the appendix ruptures.

What are the complications of appendicitis?

If it isn’t treated, a diseased appendix can rupture. A burst appendix can cause an infection that can lead to serious illness and even death. Complications include:

  • Abscess: You may develop an appendicular abscess, or a pocket of infectious pus. Your healthcare provider will place drainage tubes in your abdomen. These tubes remove fluid from the abscess before surgery. The drainage process may take a week or longer. During this time, you take antibiotics to fight infection. After the abscess is gone, you’ll have surgery to remove the appendix.
  • Abdominal infection: Peritonitis can be life-threatening if infection spreads throughout the abdomen. Abdominal surgery (laparotomy) removes the ruptured appendix and treats the infection.
  • Sepsis: Bacteria from a ruptured appendix can get into your bloodstream. If it does, it can cause a serious condition called sepsis. Sepsis causes widespread inflammation in many of your organs. It can be fatal. It requires hospital treatment with strong antibiotics.

Prevention

How can I prevent appendicitis?

There’s no proven way to prevent appendicitis. Eating a high-fiber diet with lots of whole grains and fresh fruits and vegetables may help, although experts can’t explain why.

Outlook / Prognosis

What is the prognosis (outlook) for people with appendicitis?

Because the appendix has no known purpose, you shouldn’t notice any difference after having surgery to remove it. Some people who have laparoscopic surgery go home the same day or within 24 hours. Most people return to their usual active life within two to three weeks.

You’ll need more time in the hospital (perhaps as long as a week) to recuperate from open surgery. If your appendix ruptured, you may need long-term antibiotics to clear out the infection completely. Your recovery time may take six weeks or longer.

Living With

When should I call the doctor?

If you had antibiotic-only treatment, call your healthcare provider if you notice signs of appendicitis again. You should also call your provider if you’re recovering from appendectomy surgery and you experience:

  • Constipation.
  • Fever.
  • Infected surgical site (incision), with signs of redness, swelling or yellow pus.
  • Intense pain in your lower right abdomen.

What questions should I ask my doctor?

If you have appendicitis, you may want to ask your healthcare provider:

  • Why did I get appendicitis?
  • Do I need surgery?
  • How long will it take to recover from surgery?
  • What should I expect during recovery?
  • When can I go back to work or school?
  • If I don’t have surgery, what steps can I take to prevent getting appendicitis again?
  • Should I make any dietary changes?
  • How can I help my loved ones avoid appendicitis?
  • How do signs of appendicitis differ from other stomach problems? Should I look out for signs of complications?

A note from Cleveland Clinic

Without prompt medical attention, appendicitis can be quite serious. A ruptured appendix causes widespread infection that can be deadly. See your healthcare provider if you have severe abdominal pain, a key sign of appendicitis. Your provider can rule out other causes. Appendicitis sometimes goes away with antibiotics alone. If you need surgery, a minimally invasive laparoscopic approach uses small incisions to help you recover faster.

Last reviewed by a Cleveland Clinic medical professional on 07/06/2020.

References

  • American Academy of Family Physicians (AAFP). . Accessed 7/9/2020.Appendicitis (https://familydoctor.org/condition/appendicitis/)
  • American Pediatric Surgical Association. . Accessed 7/9/2020.Acute (Early) Appendicitis (https://eapsa.org/parents/learn-about-a-condition/a-e/acute-(early%29-appendicitis/)
  • Merck Manual. . Accessed 7/9/2020.Appendicitis (https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/appendicitis)
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). . Accessed 7/9/2020.Appendicitis (https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis)

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