All About Acute Appendicitis 

Acute Appendicitis occurs due to inflammation of the appendix and is the most common abdominal surgical emergency. It frequently occurs between the ages of 10 to 20 years. However, it can affect people of all ages.

The appendix is a small tube-shaped organ that is attached to the colon. Acute appendicitis pain typically occurs in the lower right side of the abdomen. If left untreated, Appendicitis can spread to the abdominal cavity, increasing the severity, which may sometimes become fatal.

Symptoms of Acute Appendicitis

The symptoms of acute Appendicitis in adults may include:

• Sudden pain around the belly button
• Sudden central abdominal pain migrating to the lower right abdominal region
• Intensified pain during first 24 hours
• Nausea and vomiting
• Abdominal bloating, swelling and flatulence
• Diarrhea or constipation
• Loss of appetite
• Low-grade fever

Children may typically present with the following symptoms:

• Pain in the lower right abdominal region
• Low-grade fever
• Loss of appetite
• Nausea and vomiting

Causes of Acute Appendicitis

Appendicitis mainly occurs as a result of blockage of the appendix lining. Obstruction or blockage of the appendix leads to rapid multiplication of the bacteria, causing the appendix to become swollen and inflamed with pus. Various factors may be associated with blockage of the appendix, and these include:

• Hardened stool build-up
• Traumatic injuries
• Enlarged lymphoid follicles
• Viral/bacterial/parasitic infections
• Intestinal worms
• Tumors

Diagnosis and Treatment of Acute Appendicitis

Diagnosis

Appendicitis is diagnosed beginning with a physical examination followed by a series of laboratory tests. The diagnostic tests may include the following:

Physical examination: Your doctor applies gentle pressure in the lower right region of the abdomen to check for swelling, tenderness and abdominal rigidity.

Blood test: A blood sample is taken to assess the complete blood count for identification of signs of infection.

Urine test: A urine analysis is done to eliminate urinary tract infections or kidneys stones as the cause of pain.

Imaging tests: Imaging scans including abdominal X-rays, Magnetic Resonance Imaging (MRI), Computerized Tomography (CT) scan, or abdominal ultrasound may be ordered to identify other causative factors of pain and confirm the diagnosis of Appendicitis.

Treatment

Treatment of acute Appendicitis generally involves surgical removal of the inflamed appendix, which is known as appendectomy. Antibiotics are prescribed prior to the surgery. An appendectomy may be done in two ways depending on the condition of the appendix. These include:

• Open surgery: The surgery is performed through a single incision of about 4-5 inches in the lower right abdominal region.
• Laparoscopy: The surgery is performed through multiple small incisions with special surgical tools and a video camera to remove the appendix.

Although laparoscopy may allow for faster healing and recovery with lesser pain, it is not indicated for all patients. If the appendix infection has spread beyond the appendix, then open surgery may be an appropriate treatment option. Recovery may take about 1-2 days.

Complications of Acute Appendicitis

Acute Appendicitis may lead to a number of complications if left untreated. These include:

• Appendix rupture: It can cause a spread of infection to the abdominal cavity, which can possibly become life-threatening. This condition is known as peritonitis.
• Pocket of pus: An appendix burst can lead to leakage of pus and bacteria into the abdominal cavity or other organs such as the bladder or the colon.

Frequently Asked Questions

References:

Dr Jayaraj Magnus Mansard

M.S (General Surgery), DNB (Gastro), Fellow HPB & Liver transplant
Senior Consultant - GI Surgeon
Department of Minimally Invasive Bariatric & GI Surgery