It seems bizarre that your appendix, a nonessential organ, could potentially
wreak havoc on your body. But if you develop appendicitis, that is exactly what you’re facing. When it comes to this condition, time is of the essence, so we’ve compiled everything you need to identify the telltale signs in a hurry.
By Nicole Jennings
What Is Appendicitis?
“The appendix is a tubular structure, about the size of an adult’s pinky finger, that is connected to the first part of the large intestine called the cecum,” says Dr. Curt Koontz, a pediatric surgeon with University Surgical Associates. For years, it was thought to serve no function, with many saying it was likely just left over from our evolutionary past. However, more recent data suggests it may serve some immune function as storage for beneficial gut bacteria, which can help reset the digestive system after intestinal illnesses.
Whatever its purpose, when your appendix becomes inflamed, it’s called appendicitis. “Appendicitis is typically caused by obstruction or blockage of the appendix, as well as swelling of the lymphatic tissue within the appendix,” explains Dr. Koontz. “The blockage causes the blood flow to the appendix to slow, and bacteria builds up and causes infection.” If left untreated, you risk a ruptured appendix, which can cause further risks and complications.
“Fever, vomiting, loss of appetite, and increased pain with walking or movement can also be seen. The severity of symptoms and risk worsen if not quickly addressed.”
–Dr. von Gremp
Signs, Symptoms, & Complications
The first signs of appendicitis are often a low-grade fever and tenderness or pain around the belly button. Dr. Alan von Gremp, a family medicine physician with AFC Urgent Care Hixson, explains, “Pain most often starts around the navel, but usually localizes to the right lower portion of the abdomen in the first 24 hours. Fever, vomiting, loss of appetite, and increased pain with walking or movement can also be seen. The severity of symptoms and risk worsen if not quickly addressed.”
If the pain spreads across the entire abdomen, it may mean your appendix has ruptured or “perforated.” Dr. von Gremp explains, “Perforation is rare in the first 24 hours of symptoms but occurs more frequently in the elderly and in those seeking care after 36 hours.” You may feel some relief for a few hours after a rupture because the pressure in your appendix is gone, but there is a greater urgency to get to a doctor because the side effects can be dangerous.
When an appendix ruptures, bacteria can spill into the abdominal cavity and lead to peritonitis, an inflammation of the peritoneum usually caused by a bacterial infection. The peritoneum is a slick membrane that lines the walls of your abdominal cavity and coats the organs within the abdomen. Left untreated, peritonitis can move beyond your peritoneum, where it may cause a bloodstream infection, known as sepsis. Sepsis is a rapid, life-threatening condition that causes shock and eventually, organ failure.
If you’ve developed peritonitis, your symptoms will typically be similar to those you see with appendicitis, but more intense. They include constant and severe pain throughout your entire abdomen, a high fever, chills, weakness, and confusion.
Diagnosing appendicitis can be tricky because the symptoms can vary from person to person. “There are several conditions that can appear similar to appendicitis, and up to 40% of people will not have typical symptoms,” explains Dr. von Gremp.
When investigating an appendicitis diagnosis, your doctor will take a medical history, then examine the belly for signs of pain, tenderness, and inflammation. “Appendicitis is typically diagnosed from the history, physical exam, and laboratory analysis like white blood cell count and inflammatory markers,” says Dr. Koontz. “Although not always diagnostic, ultrasound is being used more frequently. Occasionally, a CT scan may be used in more ambiguous cases.”
The standard treatment for most cases of appendicitis is a surgery called an appendectomy. Before undergoing surgery, you’ll receive antibiotics to prevent possible peritonitis or other potential infections. You’ll also receive general anesthesia to put you to sleep for the duration of your surgery.
Most appendectomies are performed laparoscopically. “This means your surgeon will insert special surgical tools and a camera through small incisions in your belly button, then tie off and remove the appendix,” says Dr. Robert Jean, a surgeon at University Surgical Associates. Laparoscopic surgery is less invasive, so the incision is smaller, the hospital stay is shorter, and recovery time is quicker.
Another surgical option is called an open appendectomy. This type is more common if your appendix has ruptured, or if an abscess or peritonitis has already developed. First, your surgeon will cut a two- to four-inch incision in your lower right abdomen. Then, your abdominal muscles will be separated, and the abdominal area will be opened. Just as with the laparoscopic appendectomy, your appendix will be tied off and removed.
In some cases, if your appendix has ruptured, an appendectomy will be delayed. “Usually you let someone get better with antibiotics and drainage and wait six to eight weeks before you take the appendix out,” explains Dr. Jean. “This is called an interval appendectomy.”
After an appendectomy, you can typically return to your normal routine within a few days but should limit strenuous activity for three to four days following laparoscopic surgery or up to 14 days following open surgery. Since recovery is different for everyone, be sure to consult with your doctor.
Remember, the quickest way to recover from appendicitis is to catch it early. “If you or your child has traditional symptoms that aren’t going away, visit the doctor for an evaluation,” says Dr. Jean. “Early recognition generally leads to a better outcome and a quicker recovery.” HS
Did You Know?
Appendicitis affects 1 in 20 people. While it’s possible to develop it at any age, it is most often seen between ages 10 to 30. In all cases, it is considered an emergency and needs immediate medical attention.