What is appendicitis?

Appendicitis is inflammation of the appendix. The appendix is a thin pouch attached to the large intestine on the right side of the abdomen. It is usually about the size of a finger.

If you have appendicitis, the appendix can become swollen and infected. This can cause it to burst. If this happens, the infection is likely to spread throughout the abdomen, causing serious problems such as peritonitis (infection inside the abdomen) or an abscess around the appendix.

When should I call an ambulance?

If you think that you or someone in your care may have appendicitis, it is important that you see a doctor as soon as possible.

If you or someone in your care is in significant pain that is made worse by moving or touching the stomach, go straight to your local emergency department.

What are the warning signs/symptoms of appendicitis?

Pain is the most common symptom of appendicitis. It often starts near the navel, or belly button, and might come and go for a while. It then usually moves low down to the right in the abdomen (tummy) and becomes more severe and more constant. It usually hurts to walk or cough.

Other common signs and symptoms of appendicitis are:

• fever (high temperature)
• an abdomen which is tender to touch, especially low on the right
• nausea (feeling like throwing up)
• loss of appetite (not feeling like eating)
• vomiting, although usually only once or twice
• diarrhoea or constipation

Young children can find it hard to say where the pain is, and all you may know is that they are sick. If it is appendicitis, usually the pain will only be in the right side of the stomach. Unlike gastro, vomiting or diarrhoea are usually mild with appendicitis.

What causes appendicitis?

Appendicitis can be caused by an infection or a blockage in the appendix. Why this happens is not known, but it may be caused by food or faeces (poo) getting lodged in the appendix. The appendix becomes blocked, then inflamed, then infected. Appendicitis can occur at any age, but is most common in children and young adults.

How is appendicitis diagnosed?

The main way a doctor diagnoses appendicitis is by talking about what has happened, and examining the person with the pain.

It can be hard to diagnose appendicitis, especially in a young child. Even in adults, it can be hard to tell the difference between appendicitis and conditions like ectopic pregnancies, bowel infections and bowel obstructions. The doctor may need to examine the person with the pain a number of times.

The doctor may also do scans (an ultrasound or CT scan) and blood tests to help make the diagnosis. These can help, but don’t give a definite answer. Sometimes the doctor may recommend an operation to check the appendix even if they are not certain it is inflamed.

Since appendicitis is potentially life threatening if left untreated, doctors will err on the side of caution and operate, even if there is no firm diagnosis.

How is appendicitis treated?

The main treatment for appendicitis is an operation to remove the inflamed appendix, known as an appendectomy or appendicectomy. The appendix is not essential for health, and the body functions normally without one.

There are 2 different ways to remove the appendix:

• laparoscopic (or keyhole surgery) — through a tiny telescope. There will be 3 small keyhole cuts of about 1-2cm long each
• open — there will be a small cut across the right lower abdomen

Recovery time from surgery will vary depending on many factors, including the person’s general health, the type of surgery, and whether or not the appendix has burst.

Most people recover without too many troubles. Sometimes, the wound gets infected and this will need follow up by a doctor.

Sometimes, the appendix is found to be normal - not inflamed - after it is removed and this usually means there is another reason for the symptoms that are similar to appendicitis. Your doctor may discuss looking for another cause of the problem.

After surgery, your doctor may recommend light activity for a few weeks until the surgical wound heals.

Although surgery is the main treatment for appendicitis, sometimes antibiotics might be used instead. They do not work in all cases. Antibiotics may be used if surgery is delayed, for example, if you have to travel a long way to have the operation, or for patients who are not suitable for surgery such as being too frail. Your doctor may prescribe antibiotics before surgery to reduce the risk of infection.

Can appendicitis be prevented?

There is no proven way to prevent appendicitis.