All About Appendicitis

Appendicitis is a painful medical condition in which the appendix becomes inflamed and filled with pus, a fluid made up of dead cells that often results from an infection.

Appendicitis is the leading cause of emergency abdominal operations in the United States, according to the National Institutes of Health (NIH).

The appendix is a small, finger-shaped pouch attached to your large intestine on the lower right side of your abdomen.

It’s not entirely clear what role the appendix plays in the body, but some research suggests that it isn’t the useless organ it was once thought to be.

Though people can live perfectly normal lives without their appendix, inflammation of this abdominal organ can be a serious, life-threatening condition.

If not treated promptly, appendicitis may cause the appendix to burst, spreading an infection throughout the abdomen.

When people discuss appendicitis, they’re typically referring to acute appendicitis, which is marked by a sharp abdominal pain that quickly spreads and worsens over a matter of hours.

In some cases, however, people may develop chronic appendicitis, which causes mild, recurrent abdominal pain that often subsides on its own — these patients usually don’t realize they have appendicitis until an acute episode strikes.

Prevalence and Risk Factors for Appendicitis

Acute appendicitis now affects about 9 in 10,000 people each year in the United States (roughly 300,000 people annually) — this prevalence is higher than it was just 20 years ago, according to a 2012 report from the Journal of Surgical Research.

People of any age can get the condition, though appendicitis is most common among children and teenagers between 10 and 19 years old, according to the 2012 report.

It affects males more often than females, but scientists have yet to identify why this is the case.

Appendicitis is more common in Western societies, and may be more common in urban industrialized areas, compared with rural communities.

The typical “Western diet” that’s low in fiber and high in carbohydrates is thought to be behind this pattern.

It also appears that having a family history of appendicitis increases the risk of getting the condition for both children and adults.

The NIH estimates that almost 400 people die in the United States each year from appendicitis.

Causes of Appendicitis

It’s not always clear what causes appendicitis, but the condition often arises from one of two issues: A gastrointestinal infection that has spread to the appendix, or an obstruction that blocks the opening of the appendix.

In the second case, there are several different sources of blockage. These include:
Lymph tissue in the wall of the appendix that has become enlarged
Hardened stool, parasites, or growths
Irritation and ulcers in the gastrointestinal tract
Abdominal injury or trauma
Foreign objects, such as pins or bullets
When a person’s appendix becomes infected or obstructed, bacteria inside the organ multiply rapidly. This bacterial takeover causes the appendix to become infected and swollen with pus.

Symptoms of Appendicitis

At the onset of appendicitis, people often feel an aching pain that begins around the belly button, and slowly creeps over to the lower right abdomen.

The pain sharpens over several hours, and can spike during movement, deep breaths, coughing, and sneezing. Other symptoms of appendicitis may follow, including:

Constipation or diarrhea
Inability to pass gas
Loss of appetite
Abdominal swelling
Diagnosing Appendicitis

Because the symptoms of appendicitis are very similar to other conditions, including Crohn’s disease, urinary tract infections (UTI), gynecologic disorders, and gastritis, diagnosing appendicitis is no simple matter.

After learning about a patient’s medical history and recent pattern of symptoms, doctors will use a number of tests to help them diagnose appendicitis.

They may:

Conduct an abdominal exam to assess pain and detect inflammation
Take a blood test to determine white blood cell counts, which could indicate an infection
Order a urine test to rule out urinary tract infection and kidney stones
Perform a bimanual (two-handed) gynecologic exam in women
Use imaging tests, including computerized tomography (CT) scans, abdominal X-rays, ultrasounds, or magnetic resonance imaging (MRI) scans to confirm the appendicitis diagnosis or find other causes of abdominal pain
Treating Appendicitis

In rare cases, doctors will treat appendicitis with antibiotics, but the infection needs to be very mild.

Most often, appendicitis is considered a medical emergency, and doctors treat the condition with an appendectomy, the surgical removal of the appendix.

Surgeons will remove the appendix using one of two methods: open or laparoscopic surgery.

An open appendectomy requires a single incision in the appendix region (the lower right area of the abdomen).

During laparoscopic surgery, on the other hand, surgeons feed special surgical tools into several smaller incisions — this option is believed to have fewer complications and a shorter recovery time.
If a person’s appendix isn’t treated in time, it may burst and spread the infection throughout the abdomen, leading to a life-threatening condition called peritonitis, an infection of the peritoneum (the lining of the gut).

In other cases, abscesses may form on the burst appendix.

In both these cases, surgeons will usually drain the abdomen or abscess of pus and treat the infection with antibiotics before removing the appendix.