Appendicitis

Appendicitis happens when your appendix, a small finger-shaped structure that sticks out from your large intestine on the right side, gets inflamed and filled with pus. The inflammation is usually caused by a blockage, but may be caused by an infection.

Without treatment, an inflamed appendix can rupture, infecting the lining of the abdomen. Rupture is most common among infants, occurring in up to 95% of cases. That can be a life-threatening condition.

Appendicitis is one of the most common causes of emergency abdominal surgery.

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Signs and Symptoms

The following signs and symptoms may accompany appendicitis:

• Pain, starting around the navel, then moving down and to the right side of the abdomen. The pain gets worse when moving, taking deep breaths, coughing, sneezing, or being touched in this area.
• Loss of appetite
• Nausea and vomiting
• Change in bowel movements, including diarrhea or not being able to have a bowel movement or pass gas
• Low fever that starts after other symptoms
• Urinating often, or difficult or painful urination

What Causes It?

Appendicitis usually happens after an infection in the digestive tract, or when the tube connecting the intestine to the appendix is blocked by trapped feces or food. Both situations cause inflammation, which can lead to infection or rupture of the appendix.

Who's Most At Risk?

The following factors can put you at higher risk for developing appendicitis:

• Family history.
• Age. Children 2 years of age or younger and people 70 years of age or older are at higher risk for a ruptured appendix.

What to Expect at Your Provider's Office

Appendicitis is an emergency, because the appendix could rupture. If you have appendicitis symptoms, you should go to an emergency room.

The doctor will ask about your symptoms and your medical history, do a physical exam to check for abdominal tenderness, and may order blood and urine tests. Some health care providers use ultrasound to check whether the appendix is inflamed, and to rule out ovarian cysts or ectopic pregnancy in women. You may also have a computed tomography (CT) scan.

Treatment Options

Prevention

There is no sure way to prevent appendicitis. However, eating a diet that includes fresh vegetables and fruit may lower your risk.

Treatment Plan

Appendicitis is usually treated with surgery and antibiotics. Along with antibiotics, you may get intravenous (IV) fluids and medication to control vomiting. If your doctor can't tell from the CT scan or ultrasound whether you have appendicitis, you may have exploratory surgery. If you do have appendicitis, your appendix will be removed (appendectomy), though doctors are increasingly treating appendicitis with antibiotics only.

Drug Therapies

Your health care provider may prescribe the following medications:

• Antibiotics
• Medications to ease nausea

Surgical and Other Procedures

An appendectomy is the surgical removal of the appendix through an incision in your abdomen that can be several inches long. A laparoscopic appendectomy involves making a few tiny cuts in the abdomen and inserting a tiny camera and surgical instruments. The surgeon then removes the appendix through one of the small incisions. Recovery from a laparoscopic appendectomy is usually faster than with traditional surgery, and the scars are smaller. However, not everyone is a candidate for a laparoscopic appendectomy.

Complementary and Alternative Therapies

Acute appendicitis is an emergency, and you should get medical help immediately. Never try to treat appendicitis with alternative therapies alone. Some studies show that certain herbs and supplements may help to prevent appendicitis, strengthen your immune system, or help you recover faster from surgery.

Nutrition

In England and Wales, a study reviewed whether a diet that was low in fiber and high in sugar and meat had any effect on people getting appendicitis. No specific link was found with sugar or meat. But the study did suggest that the more fresh and frozen green vegetables and fresh and processed tomatoes people ate, the less likely they were to get appendicitis. Eating green vegetables -- particularly cabbage, cauliflower, peas, beans, Brussels sprouts and maybe tomatoes -- may protect against appendicitis.

Herbs

Appendicitis should be treated with surgery. Some herbs may help you recover faster from surgery. Ask your doctor for more information.

Prognosis and Possible Complications

With treatment, people usually make a complete recovery from appendicitis, especially if the appendix does not rupture. In cases where the appendix ruptures, the death rate is higher, especially among the elderly. The death rate after appendectoy is less than 1%.

Complications may include recurring appendicitis, inflammation of the abdominal lining, abscess (pus-filled inflamed area), sepsis or "blood poisoning," blocking of a fallopian tube, infertility, and wound infection. Appendicitis happens in only about 1 in 1,000 pregnancies.

Following Up

If you have surgery, you will need to see your health care provider 2 weeks after the operation, and again at 6 weeks.

Supporting Research

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Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:101-102.

Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T. Discriminating between simple and perforated appendicitis. J Surg Res. 2012;176(1):79-83. PMID: 22113128 www.ncbi.nlm.nih.gov/pubmed/22113128.

Fan YK, Zhang CC. 20 years' acupuncture in 461 acute appendicitis cases. Chin Med J (Engl). 1983;96(7):491-494. PMID: 6418448 www.ncbi.nlm.nih.gov/pubmed/6418448.

Garcia Peña BM, Mandl KD, Kraus SJ, et al. Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA. 1999;282(11):1041-1046. PMID: 10493202 www.ncbi.nlm.nih.gov/pubmed/10493202.

Kong V, Aldous C, Handley J, Clarke D. The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme. Ann R Coll Surg Engl. 2013;95(4):280-284. PMID: 23676814 www.ncbi.nlm.nih.gov/pubmed/23676814.

Longmire WP Jr. Invited commentary. World J Surg. 1979;3(1):130-132. PMID: 483837 www.ncbi.nlm.nih.gov/pubmed/483837.

Marx J, Hockberger R, Walls R, eds. Rosen's Emergency Medicine - Concepts and Clinical Practice. 8th ed. Philadelphia, PA; Elsevier Saunders; 2014.

McKinney PE. Elemental mercury in the appendix: an unusual complication of a Mexican-American folk remedy. J Toxicol Clin Toxicol. 1999;37(1):103-107. PMID: 10078167 www.ncbi.nlm.nih.gov/pubmed/10078167.

No author listed. Combined traditional Chinese and Western medicine in acute appendicitis. Chin Med J (Engl). 1977;3(4):266-269. PMID: 410610 www.ncbi.nlm.nih.gov/pubmed/410610.

No author listed. Treatment of acute abdominal diseases by combined traditional Chinese and Western medicine. World J Surg. 1979;3(1):91-94. PMID: 483837 www.ncbi.nlm.nih.gov/pubmed/483837.

No author listed. Treatment of acute appendicitis in children with combined traditional Chinese and Western medicine. Chin Med J (Engl). 1977;3(6):373-378. PMID: 414892 www.ncbi.nlm.nih.gov/pubmed/414892.

Pisacane A, de Luca U, Impagliazzo N, Russo M, De Caprio C, Caracciolo G. Breast feeding and acute appendicitis. BMJ. 1995;310(6983):836-837. PMID: 7711621 www.ncbi.nlm.nih.gov/pubmed/7711621.

Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338(3):141-146. PMID: 9428814 www.ncbi.nlm.nih.gov/pubmed/9428814.

Townsend CM, Beauchamp D, Evers M, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017.

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Tulin-Silver S, Babb J, Pinkney L, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol. 2014;45(6):820-830. PMID: 25471754 www.ncbi.nlm.nih.gov/pubmed/25471754.

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Review Date: 11/19/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M Editorial team.

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