What causes appendicitis: Symptoms, complications and treatment

What is Appendicitis?

Appendicitis is an inflammation of the appendix. The appendix is a small, thin, finger-shaped pouch about 5 to 10 cm long, that projects from your colon on the lower right side of your abdomen.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Appendicitis is a medical emergency that almost always requires prompt surgery to remove the appendix.

If left untreated, appendicitis can cause your appendix to burst. This can cause bacteria to spill into your abdominal cavity, which can be serious and sometimes fatal. 

Appendicitis usually affects young people aged between 10 and 20 years. A child, especially a boy, may have a greater risk for appendicitis if someone else in the family had it.

What Causes Appendicitis?

The exact cause of appendicitis is not fully understood, and so there’s no guaranteed way to prevent it. Appendicitis develops when part of the appendix becomes obstructed, or blocked.

Things that can potentially block your appendix are:

• A buildup of hardened stool
• Enlarged lymphoid follicles
• Intestinal worms
• Traumatic injury
• Tumours

Symptoms of Appendicitis

The symptoms of appendicitis in older children and teens are abdominal pain, fever, and vomiting. The pain or cramps usually start in your upper abdomen or belly button area, before moving to the lower right side of the abdomen.

In children younger than age 2, the most common symptoms are vomiting and a bloated and swollen abdomen.

Signs and symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower abdomen
• Sudden pain that begins around your navel (around your belly button) and often shifts to your lower right abdomen
• Severe cramps
• Pain that worsens if you cough, walk or make other jarring movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the illness progresses
• Constipation or diarrhoea
• Abdominal bloating
• Flatulence and indigestion
• Low-grade fever
• Painful urination and difficulty passing urine

Appendicitis is a medical emergency, and you need to get treatment quick. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture.

Complications of Appendicitis

If appendicitis is not treated, the appendix can burst and cause potentially life-threatening infections. Appendicitis can cause serious complications, such as:

• Peritonitis

If your appendix ruptures or bursts, it can spill faecal matter and bacteria into your abdominal cavity. This can cause the lining of your abdomen (peritoneum) to become infected with bacteria. This is called peritonitis.

It can also damage your internal organs.

This situation is life-threatening, and requires immediate surgery to remove the appendix, treatment with antibiotics and cleaning of your abdominal cavity.

• Abscesses

If your appendix bursts, you may develop a pocket of infection known as an abscess. This is a painful collection of pus that forms when the body tries to fight the infection. 

Abscesses can sometimes be treated using antibiotics, but in most cases the pus needs to be drained from the abscess.

Once the infection is clear, you will have surgery to remove the appendix. In extremely rare cases, an abscess can also form as a complication of appendix removal surgery.

How is Appendicitis Diagnosed?

Diagnosing appendicitis can be tricky. Symptoms of appendicitis are usually similar to other ailments such as gastroenteritis, severe irritable bowel syndrome (IBS), constipation, bladder or urinary tract infection, Crohn’s disease and ovary problems.

Your doctor will ask about your symptoms, examine your abdomen, and press on the area around your appendix (the lower right-hand side of your abdomen) to see if the pain gets worse. He/she will check for tenderness in the lower right part of your abdomen and swelling or rigidity.

The following tests may be used to help make the diagnosis:

• Abdominal exam to detect inflammation
• Urine test to rule out a urinary tract infection
• Pregnancy test for women
• Rectal exam
• Blood test to look for signs of infection
• An ultrasound scan to see if the appendix is swollen
• CT scan or magnetic resonance imaging (MRI) 

If your doctor suspects that your appendix has burst, you will be sent to hospital immediately for treatment.

Treatment of Appendicitis

If you have appendicitis, your appendix will usually need to be removed as soon as possible. If the appendix is removed surgically before it bursts, complications are rare. Removal of the appendix is known as an appendicectomy or appendectomy. It is commonly carried out as keyhole surgery (laparoscopy).

Laparoscopic surgery allows you to recover faster and heal with less pain and scarring. 

Open surgery may be used when the appendix has burst and the infection has spread beyond the appendix, or access is more difficult. Before surgery you may be given a dose of antibiotics to treat infection.

You will have to spend 2-3 days in the hospital after your appendix has been removed. It will take you around 2 weeks to make a full recovery after an appendectomy. Strenuous activities may need to be avoided for up to 6 weeks after having an open surgery.

After an appendectomy, call your doctor if you have:

• Uncontrolled vomiting
• Increased pain in your abdomen
• Dizziness/feelings of faintness
• Blood in your vomit or urine
• Increased pain and redness in your incision
• Fever
• Pus in the wound

If the appendix has formed an abscess, you may have two procedures- one to drain the abscess of pus and fluid, and another one later to remove the appendix.

Some research shows that treatment of acute appendicitis with antibiotics may eliminate the need for surgery in certain cases.