- What Causes Appendicitis? Obstructions and Other Contributors
- The Possible Complications of Appendicitis
- What Are the Risk Factors for Appendicitis?
- What is appendicitis?
- Appendicitis symptoms
- Does your child need to see a doctor about appendicitis pain?
- Tests for appendicitis
- Treatment for appendicitis
- Causes of appendicitis
- What causes appendicitis?
- Who is at risk for appendicitis?
- What are the symptoms of appendicitis?
- How is appendicitis diagnosed?
- How is appendicitis treated?
- Complications of Appendicitis
- Can appendicitis be prevented?
- When should I call my healthcare provider?
- Key Points About Appendicitis
- Next Steps
What Causes Appendicitis? Obstructions and Other Contributors
Appendicitis is often the result of an obstruction in the area inside the appendix called the appendiceal lumen. Alamy
Appendicitis is a serious medical condition in which the appendix — a small, finger-shaped organ attached to your large intestine — becomes swollen and inflamed. It’s not always clear what causes appendicitis. Often, appendicitis is probably the result of an obstruction of the area inside the appendix called the appendiceal lumen (the interior of the tube of the appendix), or appendix lumen. (1)
There are numerous issues that can cause appendix luminal blockage, including:
- Appendicoliths or fecaliths, which are calcified fecal deposits, also known as “appendix stones” (this is more common in children than adults) (2)
- Intestinal worms or parasites, including pinworm (Enterobius vermicularis)
- Irritation and ulcers in the gastrointestinal (GI) tract resulting from long-lasting disorders, such as Crohn’s disease or ulcerative colitis
- Abdominal injury or trauma
- Enlarged lymph tissue of the wall of the appendix, which is typically the result of infections in the GI tract
- Benign or malignant tumors
- Various foreign objects, such as stones, bullets, air gun pellets, and pins (3)
Sometimes appendicitis is due to a viral, bacterial, or fungal infection that has spread to the appendix. (4) Possible causes of infection include, but are not limited to:
- E. coli, which are bacteria found in the environment, foods, and intestines of animals. Most strains of E. coli are harmless, but others can cause illness. (5)
- Pseudomonas bacteria, which are found in soil and water and moist areas such as sinks and toilets (6)
- Bacteroides, bacteria that already inhabit the digestive tract of humans (7)
- Adenovirus, a very common virus spread through contact or through the air that can cause cold-like symptoms as well as bladder and other infections. (8)
- Salmonella, a foodborne bacteria that typically causes gastrointestinal upset (diarrhea, nausea, and vomiting) but can have serious complications
- Shigella bacteria, germs that are very contagious and typically result in diarrheal illness that usually lasts no more than a week. (9)
- Measles, a highly contagious virus spread through the air and contact. Vaccination protects most of the population, but there are outbreaks in which unvaccinated people are susceptible (10)
- The fungal infections mucormycosis (a rare but serious mold infection caused by environmental molds) (11) and histoplasmosis; most people who breathe in these spores won’t get sick or will have mild symptoms, but infection can become severe in people with weakened immune systems (11)
Your appendix is home to many beneficial bacteria. In fact, recent research has focused on the role the appendix might play in immune function. Long considered to be a vestigial organ without much purpose, the appendix, some experts now think, is involved in both encouraging and protecting the growth of beneficial gut bacteria: When certain diseases destroy beneficial gut bacteria in the GI tract, the appendix helps to recolonize the gut after infection. (12)
But when the organ becomes infected or obstructed, bacteria in the appendix multiply rapidly, causing your appendix to swell and fill with pus — a thick liquid containing bacteria, tissue cells, inflammatory debris, and dead infection-fighting white blood cells.
The Possible Complications of Appendicitis
If left untreated, appendicitis will often get progressively worse as the inflammation leads to further complications.
Pressure within the appendix will increase, limiting the amount of blood flowing through the walls of the appendix, where the tissue then becomes starved of blood and starts to die.
Eventually, the appendix will rupture, leaking its contents throughout the abdomen. In some cases, abscesses (pockets of pus) may form on the ruptured appendix; if the abscesses tear, they can infect the rest of the abdomen.
In other cases, the ruptured appendix may cause the peritoneum — the silk-like membrane that lines the abdominal cavity — to become infected, a condition called peritonitis. This serious complication can then lead to a potentially fatal blood infection called sepsis.
What Are the Risk Factors for Appendicitis?
There’s no way to predict who will get appendicitis, but scientists have uncovered several risk factors for the condition. These include:
- Being a teenager or in your twenties; (13) most cases of appendicitis occur in this age group
- Having a long-lasting inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- Studies have suggested that family history plays a role; a study published in 2014 in the Western Journal of Emergency Medicine found that among adults at an emergency room who presented with appendicitis, those with a known family history were more likely to have the condition (14)
And a study published in 2001 in the Journal of Pediatric Surgery found that “heredity is a significant factor” in children who have appendicitis. (15)
There’s also a link between air pollution — in particular, high levels of ozone — and appendicitis. Scientists aren’t sure why air pollution is associated with an increased risk of appendicitis, but it may be that high levels of ozone increase intestinal inflammation or increase susceptibility to bacterial and viral infections. (16)
Studies suggest that people get appendicitis more during the summer than at other times of the year. It’s not clear why, but a review of over 40 years of research, published in February 2014 in Annals of Medical and Health Sciences Research, concludes that it’s likely due to a combination of increased exposure to air pollution and more GI infections during summer months. (17)
Since the late 1800s, doctors have turned to surgery to treat appendicitis, even though an inflamed appendix sometimes gets better on its own. A new report suggests that trying intravenous antibiotics first works as well as surgery for some people.
The appendix is a small pouch that hangs off the large intestine. It usually sits in the lower abdomen just above the right hip bone. No one really knows what the appendix does, if anything. It may be a holdover from our evolutionary past. It may also harbor beneficial bacteria, or be involved in fetal development or the immune system.
No matter what its role, the appendix can become inflamed. This condition, known as appendicitis, is one of the most common causes of severe abdominal pain. If an inflamed appendix breaks open and spills bacteria into the abdomen, it can trigger peritonitis, a potentially dangerous infection of the tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.
Removing an inflamed appendix is one way to make sure it won’t cause peritonitis—or any future problems, for that matter. Thanks to laparoscopic (“keyhole”) surgery, removing an appendix is a relatively simple procedure.
Doctors have known for years, and CT scans have proved, that appendicitis often doesn’t lead to a burst appendix. Some physicians have used antibiotics as an alternative to immediate surgery when appendicitis is uncomplicated, meaning the appendix is swollen but hasn’t burst.
To see how well this works, researchers from Nottingham University Hospitals in England compiled the results of four randomized clinical trials that compared antibiotics and surgery for uncomplicated appendicitis. Here’s what they found:
- Antibiotics alone successfully treated appendicitis 63% of the time
- People who received antibiotics instead of surgery were 39% less likely than those who underwent surgery to have developed complications such as a perforated appendix, peritonitis, or infection around the appendectomy incision.
- About 20% of those treated with antibiotics had a return of pain or other symptoms and needed to go back the hospital; some of these had serious infections brewing.
The work was published in the British Medical Journal (BMJ).
Not a game changer
The authors concluded that administering antibiotics early “merits consideration as the initial treatment option for uncomplicated appendicitis.” But their work isn’t likely to immediately change the way appendicitis is treated in the United States.
For one thing, researchers would need to find simple, solid ways to identify who would—and who wouldn’t—be candidates for antibiotic therapy.
“Antibiotics first certainly wouldn’t be a one-size-fits-all approach,” said Dr. Andrew L. Warshaw, surgeon-in-chief emeritus at Massachusetts General Hospital and professor of surgery at Harvard Medical School. For older people, those with other health problems, and those at high risk for developing peritonitis, surgery first may be a safer option.
It would also be important to tally up the total costs of giving antibiotics and performing surgery, including the cost of treating complications and the cost of rehospitalization.
For now, most doctors will probably continue to recommend surgery to treat an inflamed appendix. But if you find yourself with appendicitis and your doctor suggests trying antibiotics first, he or she isn’t crazy and it just might work.
What is appendicitis?
Appendicitis is an inflammation of the appendix – that is, the appendix gets red, swollen and irritated. The appendix is a small finger-like tube that grows out of the large bowel.
The main symptom of appendicitis is stomach pain.
Appendicitis pain usually starts in the middle of your child’s stomach near his belly button. It might feel like a dull cramp. Over the next few hours, the pain becomes sharper. Sometimes the pain can shift from being all over the stomach to the lower right side of the stomach, over the appendix.
Your child might be more uncomfortable when she’s trying to sit upright or walk straight. The pain will often get worse when she moves.
Your child might also have fever, vomiting, loose poo and no appetite.
School-age children and teenagers are more likely to get appendicitis than preschool children and babies. The symptoms of appendicitis aren’t as clear in young children as in teenagers or adults. You might not even know that a young child has tummy pain.
Does your child need to see a doctor about appendicitis pain?
Yes. If your child has tummy pain that’s getting worse, take your child to the GP or hospital emergency department.
If your child is extremely unwell and even a small amount of movement causes him pain, take him to a hospital emergency department straight away. You might need to call an ambulance in this situation – phone 000.
There’s always a risk of the inflamed appendix bursting and releasing pus into the abdomen. This is called a ruptured appendix. This isn’t very common, but without treatment it can be life-threatening.
Tests for appendicitis
Appendicitis can be difficult to diagnose.
Your GP or the emergency department doctor might get your child to do a urine test. This will rule out a urinary tract infection, which can look a lot like appendicitis.
Your child might also have a blood test to see whether there’s evidence of infection or inflammation somewhere in her body.
The doctor might also order an abdominal ultrasound. But this test might not always be helpful.
Treatment for appendicitis
Surgery to remove the inflamed appendix is the only treatment for appendicitis.
There are two kinds of surgery to take out an appendix:
- Keyhole surgery (laparoscopy) is where a camera and special instruments are inserted through three small cuts in different parts of your child’s abdomen.
- Open surgery is where a single, larger cut is made in your child’s abdomen.
As the appendix doesn’t seem to have a function in food digestion, your child won’t have any problems if it’s taken out.
Causes of appendicitis
We don’t know what causes appendicitis. One theory is that if food or poo gets stuck in the appendix, it can cause a blockage, which can then get infected with bacteria.
We also don’t really know why we have an appendix or what it’s supposed to do in our bodies. It might just be a body part left over from human evolution.
The appendix is a thin tube that is joined to the large intestine. It sits in the lower right part of your belly (abdomen). When you are a young child, your appendix is a working part of your immune system, which helps your body to fight disease. When you are older, your appendix stops doing this and other parts of your body keep helping to fight infection.
The appendix can get infected. If not treated it can burst (rupture). This can happen as soon as 48 to 72 hours after you have symptoms. Because of this, appendicitis is a medical emergency. If you have symptoms, see a doctor right away to avoid more infection, which can be life-threatening.
What causes appendicitis?
Appendicitis happens when the inside of your appendix is blocked. Appendicitis may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract. Or it may happen when the tube that joins your large intestine and appendix is blocked or trapped by stool. Sometimes tumors can cause appendicitis.
The appendix then becomes sore and swollen. The blood supply to the appendix stops as the swelling and soreness get worse. Without enough blood flow, the appendix starts to die. The appendix can burst or develop holes or tears in its walls, which allow stool, mucus, and infection to leak through and get inside the belly. The result can be peritonitis, a serious infection.
Who is at risk for appendicitis?
Appendicitis affects 1 in 1,000 people living in the U.S. Most cases of appendicitis happen to people between the ages of 10 and 30 years. Having a family history of appendicitis may raise your risk, especially if you are a man. For a child, having cystic fibrosis also seems to raise the risk of getting appendicitis.
What are the symptoms of appendicitis?
The following are common symptoms of appendicitis. Your own symptoms may vary.
Pain in the abdomen is the most common symptom. This pain:
- May start in the area around your belly button and move to the lower right-hand side of your belly. It may also start in the lower right-hand side of your belly.
- Often gets worse as time goes on.
- May feel worse when you are moving, taking deep breaths, being touched, and coughing or sneezing.
- May be felt all over your belly if your appendix bursts.
Other common symptoms include:
- Upset stomach and vomiting
- Loss of appetite
- Fever and chills
- Trouble having a bowel movement (constipation)
- Loose stool (diarrhea)
- Trouble passing gas
- Swollen belly
Do not take pain medicines. They may hide other symptoms your healthcare provider needs to know about.
Appendicitis symptoms may look like other health problems. Always see your healthcare provider to be sure.
How is appendicitis diagnosed?
Your healthcare provider will ask about your past health and do a physical exam. He or she may also have you take the following tests:
- Blood tests: To check for signs of infection, such as having a high white blood cell count.
- Urine tests: To see if you have a urinary tract infection.
You may also have some imaging tests, including:
- Abdominal ultrasound: Lets the doctor see internal organs as they work and checks how blood is flowing through different blood vessels.
- CT scan: Shows detailed images of any part of the body, such as the bones, muscles, fat, and organs.
- MRI: Sometimes used to diagnose appendicitis, especially in a pregnant woman, instead of CT scan.
How is appendicitis treated?
Appendicitis is a medical emergency. It is likely the appendix will burst and cause a serious, deadly infection. For this reason, in almost all situations, your healthcare provider will advise that you have surgery to remove your appendix.
The appendix may be removed in an open procedure or using laparoscopy:
- Open (traditional) surgery method. You are given anesthesia. A cut (incision) is made in the lower right-hand side of your belly. The surgeon finds the appendix and takes it out. If the appendix has burst, a small tube (shunt) may be placed to drain out pus and other fluids in the belly. The shunt will be taken out in a few days, when your surgeon feels the infection has gone away.
- Laparoscopic method. You are given anesthesia. This surgery uses several small cuts (incisions) and a camera (laparoscope) to look inside your belly. The surgical tools are placed through a few small incisions. The laparoscope is placed through another incision. A laparoscopy can often be done even if the appendix has burst.
If your appendix has not burst then your recovery from an appendectomy will only take a few days. If your appendix has burst, your recovery time will be longer and you will need antibiotic medicine.
You can live a normal life without your appendix. Changes in diet or exercise are usually not needed.
Complications of Appendicitis
The main problem with appendicitis is the risk of a burst appendix. This may happen if the appendix is not removed quickly. A burst appendix can lead to infection in the belly, called peritonitis. Peritonitis can be very serious and even cause death if not treated right away.
Can appendicitis be prevented?
At this time, there is no known way to stop appendicitis from happening.
When should I call my healthcare provider?
If you have any of the symptoms of appendicitis listed above, call your healthcare provider right away. Or go to an emergency department. Appendicitis is a serious medical emergency. It should be treated as quickly as possible.
Key Points About Appendicitis
Appendicitis is when your appendix becomes sore, swollen, and diseased.
- It is a medical emergency. You must seek care right away.
- It happens when the inside of your appendix gets filled with something that causes it to swell, such as mucus, stool, or parasites.
- Most cases of appendicitis happen between the ages of 10 and 30 years.
- It causes pain in the belly, but each person may have different symptoms.
- Your health care provider will advise that you have surgery to remove your appendix.
- You can live a normal life without your appendix.
Tips to help you get the most from a visit to your healthcare provider:
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.