DefinitionAppendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the beginning of your large intestine.
Causes, incidence, and risk factorsAppendicitis is one of the most common causes of emergency abdominal surgery in the United States. It usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.
SymptomsThe symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age.The first symptom is often pain around your belly button. (See: Abdominal pain) The pain may be minor at first, but it becomes more sharp and severe. Your appetite will be reduced, and you may have nausea, vomiting, and a low fever.As the swelling in the appendix increases, the pain tends to move into your right lower abdomen. It focuses right above the appendix at a place called McBurney's point. This most often occurs 12 to 24 hours after the illness starts.If your appendix breaks open (ruptures), you may have less pain for a short time and you may feel better. However, once the lining of your abdominal cavity becomes swollen and infected (a condition called peritonitis), the pain gets worse and you become sicker.Your pain may be worse when you walk or cough. You may prefer to lie still because sudden movement causes pain.Later symptoms include:ChillsConstipationDiarrheaFeverNauseaShakingVomiting
Signs and testsIf you have appendicitis, your pain will increase when the doctor gently presses on your lower right belly area. If you have peritonitis, touching the belly area may cause a spasm of the muscles.A rectal exam may find tenderness on the right side of your rectum.Doctors can usually diagnose appendicitis by:Your description of the symptomsThe physical examLab testsIn some cases, other tests may be needed, including:Abdominal CT scanAbdominal ultrasound
TreatmentIf you do not have complications, a surgeon will usually remove your appendix soon after your doctor thinks you might have the condition. For information on this type of surgery, see: Appendectomy.Because the tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.If a CT scan shows that you have an abscess from a ruptured appendix, you may be treated for infection. You will have your appendix removed after the infection and swelling have gone away.
Expectations (prognosis)If your appendix is removed before it ruptures, you will likely get well very soon after surgery. If your appendix ruptures before surgery, you will probably recover more slowly, and are more likely to develop an abscess or other complications.
ComplicationsAbnormal connections between abdominal organs or between these organs and the skin surface (fistula)AbscessBlockage of the intestineInfection inside the abdomen (peritonitis)Infection of the surgical wound
Calling your health care providerCall your health care provider if you have abdominal pain in the lower-right portion of your belly, or any other symptoms of appendicitis. Also call your doctor if:Your pain is severe, sudden, or sharpYou have a fever along with your painYou are vomiting blood or have bloody diarrheaYou have a hard abdomen that is tender to touchYou are unable to pass stool, especially if you are also vomitingYou have chest, neck, or shoulder painYou are dizzy or light-headedYou have nausea and a lack of appetite with your painYou are losing weight that you did not mean to loseYou have yellowing of your eyes or skinYou have bloating for more than 2 daysYou have diarrhea for more than 5 days, or your infant or child has had diarrhea for 2 days or vomiting for 12 hours (call right away if a baby younger than 3 months has diarrhea or vomiting)You have had abdominal pain for more than 1 weekYou have burning with urination or you are urinating more often than usualYou have pain and may be pregnantYour pain gets worse when you take antacids or eat something
ReferencesBen-David K, Sarosi GA Jr. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 116.Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298:438-451.Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011;54:43-53.