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Appendicitis

Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to the large intestine.

Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to the large intestine.

Appendicitis typically starts with a pain in the middle of your abdomen (tummy) that may come and go. Within hours the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.

Pressing on this area, coughing or walking, may all make the pain worse. You may lose your appetite, feel sick and occasionally experience diarrhoea.

Read more about the symptoms of appendicitis.

When to get medical help

If you're experiencing abdominal pain that's gradually getting worse, contact your GP or local out-of-hours service immediately. If these options aren't available, call NHS 111 for advice.

You should call 999 for an ambulance if you have pain that suddenly becomes and continues to get worse and spreads across your abdomen. These are signs that your appendix may have burst, which can lead to potentially life-threatening complications.

Read more about diagnosing appendicitis and the complications of appendicitis.

How appendicitis is treated

In most cases of appendicitis, the appendix will need to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most common operations in the UK and its success rate is excellent.

The operation is most commonly performed as 'keyhole' surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted. 'Open' surgery, where a single larger cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult.

Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to six weeks after open surgery. 

Read more about treating appendicitis.

What causes appendicitis?

It's not exactly clear what the causes of appendicitis are, although most cases are thought to occur when something, usually a small piece of faeces (stool) or a swollen lymph node within the wall of the bowel (often following an upper respiratory tract infection), blocks the entrance of the appendix.

This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting.

As the causes are not fully understood, there's no guaranteed way of preventing appendicitis.

Who is affected

Appendicitis is a common condition. Around 40,000 people are admitted to hospital with appendicitis each year in England and it's estimated that around one in every 13 people will develop it at some point in their life.

Appendicitis can develop at any age, but it is most common in young people from 10 to 20 years old.


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Appendicitis

Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases.

Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases.

Also, some people's appendix may be located in a slightly different part of their body, such as the pelvis, behind the large intestine or behind the liver.

Some people develop pain similar to appendicitis, but it's caused by something else, such as a bladder or urine infectionCrohn's disease or gastroenteritis.

Your GP will ask about your symptoms, examine your abdomen and see if the pain gets worse when pressure is applied to the appendix area (your lower right-hand side).

If your symptoms are typical of appendicitis, this is normally enough for your GP to make a confident diagnosis, in which case you will be referred immediately to hospital for treatment.

Further tests

However, if your symptoms are not typical, further tests may be required in hospital to confirm the diagnosis and rule out other conditions.

Further tests may involve: 

It can sometimes take several days to get test results. Therefore it is likely you will be advised to have your appendix removed if appendicitis is suspected, rather than run the risk of it bursting. This means that some people will have their appendix removed even though it is eventually found to be normal.

In some cases where a diagnosis is not certain, a doctor may recommend waiting up to 24 hours to see if your symptoms improve, stay the same, or get worse.

If your doctor suspects that your appendix has burst, you will be sent to hospital immediately for treatment.

Read more about treating appendicitis.


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Appendicitis

If appendicitis is not treated, the appendix can burst and cause potentially life-threatening infections.

If appendicitis is not treated, the appendix can burst and cause potentially life-threatening infections.

Call 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs that your appendix may have burst.

Peritonitis

If your appendix bursts, it releases bacteria into other parts of the body. This can cause a condition called peritonitis if the infection spreads to the peritoneum (the thin layer of tissue that lines the inside of the abdomen).

Symptoms of peritonitis can include:

  • severe continuous abdominal pain
  • feeling sick
  • being sick
  • a high temperature (fever)
  • a rapid heartbeat
  • shortness of breath with rapid breathing
  • swelling of the abdomen

If peritonitis is not treated immediately it can cause long-term problems and may even be fatal. Treatment for peritonitis usually involves antibiotics and the surgical removal of the appendix (appendectomy).

Read more about treating peritonitis.

Abscesses

Sometimes an abscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the body’s attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about 1 in 500 cases.

Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus will need to be drained from the abscess. This can be carried out under ultrasound or computerised tomography (CT) guidance using local anaesthetic and a needle inserted through the skin followed by placement of a drain.

If an abscess is found during surgery, the area is carefully washed out and a course antibiotics is given.

Read more about treating abscesses.


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