If your appendix burst

Appendicitis: What you need to know

Share on PinterestAppendicitis can cause pain in the lower, right-hand side of the abdomen.

The appendix is about 4 inches long and is situated on the right, lower side of the abdomen. It is a tube-shaped piece of tissue that is closed at one end. It is attached to the cecum, a pouch-like portion of the colon, or large intestine.

Severe and sudden abdominal pain is usually the first symptom of appendicitis.

The pain often begins near the belly button. As it worsens, it will likely shift to the lower right side of the abdomen.

The feeling may become more intense within the next few hours and be worsened by moving around, taking deep breaths, coughing, or sneezing.

Other classic symptoms of appendicitis are:

  • nausea
  • vomiting
  • loss of appetite
  • constipation or diarrhea
  • inability to pass gas
  • low-grade fever and chills
  • a temperature between 99° and 102° Fahrenheit
  • stomach swelling
  • wanting to have a bowel movement to relieve discomfort

However, these symptoms appear in only 50 percent of cases.

Some patients may experience symptoms such as stomach pain very slightly or not at all. Others may have less common symptoms.

Symptoms in children and infants

Children and infants may not experience pain in one specific area. There may be tenderness throughout the body, or there may be no pain.

Children and infants may have less frequent or no bowel movements. If diarrhea occurs, this may be a symptom of another illness.

While children and infants may not experience precise pain as older patients do, research suggests that abdominal pain is still the most common symptom of appendicitis symptom for this age group.

Symptoms in older adults and during pregnancy

Older adults and pregnant women may also experience different symptoms. The stomach pain may be less severe and less specific. Possible symptoms include nausea, vomiting, and fever.

During pregnancy, the pain may shift upward toward the upper right quadrant after the first trimester. There may also be some back or flank pain.

If there is stomach pain, this may result from another condition.

Other conditions with similar symptoms

Abdominal pain can be a symptom of other conditions that seem like appendicitis.

Examples include:

  • stomach lesions
  • constipation
  • inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis
  • stool, parasites, or growths that clog the inside of the appendix
  • damage or injury to the abdomen

When to see a doctor

Appendicitis can be life-threatening, and it requires immediate medical care. It is likely to worsen the longer it is left untreated. Initial symptoms may feel like gas.

If over-the-counter (OTC) medications do not relieve the gas, or if there is severe and worsening pain, the individual should see a doctor at once. It may be advisable to go straight to the emergency room.

Treating appendicitis as soon as symptoms appear will prevent it from worsening and causing further complications.

Most people are pretty familiar with run-of-the-mill tummy troubles like constipation and diarrhea. You’ve probably also had the displeasure of experiencing food poisoning or a stomach virus at least once or twice in your life. While appendicitis is much less common, about 5% of the population eventually ends up with it, and if you fall into that unlucky group, you’ll need to figure it out as soon as possible.

“If it is not treated, your appendix can rupture, which can be life-threatening,” says Jennifer Caudle, DO, a board-certified family physician and assistant professor at Rowan School of Osteopathic Medicine.

Not every case of appendicitis will lead to the organ bursting, but the longer the condition goes unchecked, the greater the risk. Here are some warning signs that warrant a call to your doc—or maybe even a trip to the ER.

Your stomach hurts more than it ever has before.

Appendicitis usually causes severe pain that extends from the belly button to the lower right side of the abdomen, says Caudle. While this doesn’t necessarily mean your appendix is about to burst, you may need an imaging test, like a CT scan, to find out.

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Dan Gingold, MD, an emergency physician at Mercy Medical Center in Baltimore, notes that some appendicitis patients have a different type of discomfort: If it hurts when you’re doing things like walking, coughing, or going over a bump in a car, your whole abdominal wall could be inflamed. Your appendix might be on the verge of bursting, or it might have already ruptured. See a doc stat.

You’re nauseous, vomiting, and have no appetite.

You might just be battling a stomach bug, and not everyone with appendicitis will have these symptoms. But if you’re feeling really queasy in addition to having bad pain, get checked out. “Inflammation of the appendix sometimes impacts other aspects of the GI tract and the nervous system and leads to nausea and vomiting,” says Caudle.

These symptoms could mean you’re too stressed out:

You’re running to the bathroom a lot more than usual.

In some people, the appendix is positioned lower in the pelvis, so it’s pretty close to the bladder. And when the bladder comes into contact with an inflamed appendix, the bladder also becomes inflamed and irritated, says Cedrek McFadden, MD, a board-certified GI surgeon at the University of South Carolina School of Medicine Greenville and the Greenville Health System. As a result, you may feel like you have to pee all the time—and it hurts when you do. Of course, this could also signal a UTI, but when coupled with other symptoms on this list it could point to appendicitis. (These are the 8 most common causes of UTIs.)

You’re shivering and running a fever.

A fever and chills means there’s inflammation somewhere in your body. If your appendix is inflamed, “the body responds by releasing several chemicals to ring the alarm and bring fighter cells to the area, which can manifest as localized pain as well as whole-body symptoms like fever and chills,” says McFadden. If you also have stomach pain—or if your fever is worsening—consult your doctor.

You’re not all there.

If you’re confused or disoriented, that might mean the infection is getting worse; it might have even entered your bloodstream (aka sepsis), which can be fatal, says Gingold. “It’s not that anything is going on in the brain—just that the infection is getting worse and expending a lot of body resources including oxygen, so the brain doesn’t get enough and doesn’t work normally,” he explains. Any time someone is acting erratically, don’t delay: Whether it turns out to be appendicitis or something else that can alter their mental state (like a stroke), the sooner you get help the better.

Judy Koutsky Judy Koutsky’s work has appeared in over 30 publications including Conde Nast Traveler, Travel + Leisure, Parents, Prevention and Scholastic.

What doesn’t kill you makes you stronger, stand a little taller, right? Common Health blog begins a narrative post on one woman’s burst-appendix survival with a warning that I’ll repeat before going any further:

A perforated appendix can kill you. If you experience symptoms of appendicitis, particularly sharp pain in the lower right area of your abdomen, get prompt medical care.

Now, the story. WBUR’s news director, Martha Little, shares her experience with writer Carey Goldberg, who reports that treatment for appendicitis may be evolving from automatic emergency-room surgery to more nuanced and less invasive treatments. Little tells her story from the first instance of abdominal pain to entering a hospital. She writes:

I finally made it to the Brigham & Women’s emergency room, where I was told I would likely have the appendix taken out that night. But upon further examination, the surgeon and his resident told me that I could wait eight weeks for surgery, and meanwhile they would treat the infection with serious antibiotics.

Eight weeks!? “What,” I said, “would happen if the appendix burst?”

“It has already burst,” they said.

What? I thought people died when their appendix burst.

No, I was told. Not always.

The body, they explained, has a way of “walling off” the perforated appendix so that the infection doesn’t spread.

Goldberg writes:

Here’s the good news for patients like Martha: The appendix is surrounded by other structures, mostly the intestine, and so, as she was told, the seepage can get “walled off.” One theory, said, is that a somewhat mobile layer of visceral fat called the omentum — nicknamed “the policeman of the abdomen” — could be drawn toward areas of inflammation to contain infection. So a patient can end up with a pus-filled abscess outside the appendix, covered partially by the omentum.

Still, why not just operate and get rid of the problem? It’s not so simple. An area rife with inflammation is hard for surgeons to work with, Dr. Smink said, and an appendectomy could end up turning into removal of part of the intestine and colon as well.

So the idea is to give the patient antibiotics to fight the infection, wait as the inflammation subsides and then do an “interval appendectomy,” after the waiting interval.

It should be noted that some research has shown that for some cases of uncomplicated appendicitis, with the appendix still intact, antibiotic treatment may be an effective alternative to surgery.

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If you’ve ever had severe stomach pain, you’ve probably Googled “how to know if your appendix burst.” It’s natural that your mind immediately goes to your appendix since there are only so many reasons you might be experiencing severe stomach pain.

Indeed, appendicitis (inflammation of the appendix) is the most common reason behind emergency abdominal surgery in the U.S., with 250,000 appendectomies performed each year, according to Harrison’s Principles of Internal Medicine, the leading textbook on internal medicine. If surgery isn’t performed quickly enough it can lead to a ruptured appendix, which can result in a life-threatening infection called peritonitis, according to the Mayo Clinic.

So, yeah, it’s a good idea to get to the emergency room right away if you think you have appendicitis. But how do you know if your stomach pain is appendicitis or if it’s actually progressed into a ruptured appendix? Keep reading to learn exactly how to know if your appendix burst.

First, let’s talk about what your appendix is.

The appendix is a finger-shaped pouch that sits in the lower right section of your abdomen, according to the Mayo Clinic. When you’re a kid, it’s an important part of your immune system, which helps your body fight disease; but as you get older, it stops doing this and is no longer needed, per John Hopkins Medicine. That’s why if yours is acting up, doctors will make quick work of removing it.

What is appendicitis?

Appendicitis occurs when the appendix becomes inflamed. This is usually due to a blockage inside your appendix that causes it to swell up and get infected, according to Johns Hopkins Medicine. As the swelling gets worse, blood flow to the appendix stops, eventually causing it to burst. At that point, the appendix walls get holes in them that release things like stool and mucus.

Here are the signs and symptoms of appendicitis, according to the National Institute of Diabetes and Digestive and Kidney Diseases:

  • Pain that worsens quickly and starts near your belly button and then migrates to your lower right side
  • Pain that gets worse when you move, breathe, cough, or sneeze
  • Pain that’s severe and unlike anything you’ve ever experienced
  • Pain that’s so bad it wakes you up in the middle of the night
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Not being able to pass gas
  • A fever
  • A swollen belly
  • Feeling like a bowel movement would make you feel better

Here’s how to know if your appendix burst.

While appendicitis is often treatable, the severity of the condition and a person’s outcome changes once their appendix ruptures, Sanford Vieder, D.O., medical director of Lakes Urgent Care in West Bloomfield and Livonia, Michigan, tells SELF.

Ruptures or perforated appendixes happen in a minority of appendicitis cases, Diya Alaedeen, M.D., a general surgeon at Cleveland Clinic tells SELF, and it’s more common in elderly patients. However, it does happen in younger people as well.

Sarah Chima, M.D., general surgeon at New Jersey’s Newton Medical Center tells SELF that there are a few risk factors that increase the odds your appendix will burst. Those include having diabetes, taking chronic pain medications or steroids, and waiting more than three days after your symptoms started to get help.

Of all your body’s many functions, modern medicine is still confused about one thing: the appendix. It’s possible your appendix fights off some infections, but doctors aren’t quite sure.

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We all can survive without the 2-to-4-inch, worm-shaped organ. But if it happens to get infected or bursts — causing appendicitis — you’re in trouble. You’ll need medical attention right away, says general surgeon William O’Brien, MD.

“Appendicitis is a serious condition,” he says. “And, it’s always an emergency.”

How do you know if you’re at risk?

Dr. O’Brien says, everyone has a low risk — roughly 7% — for developing appendicitis during their life. However, it’s most common among children, ages 10 to 19. In fact, it’s the most frequent reason for emergency surgery in kids.

Appendicitis isn’t hereditary, and you can’t pass it to others. But there’s nothing you or your doctor can do to prevent it or reduce your risk of getting it, he says.

Why would your appendix get infected?

The appendix gets infected when there’s a blockage, Dr. O’Brien explains.

Blockages can be caused by:

  • Inflammation.
  • Bacteria.
  • Viruses.
  • Hardened fecal matter.
  • Parasites.
  • Enlarged tissues.
  • Ulcers.
  • Abdominal rips or tearing.

Left untreated, an infection can cause your appendix to burst. This can spread the infection and may cause inflammation in the lining of the abdomen.

What symptoms should you watch for?

Fortunately, appendicitis symptoms show up quickly — usually within the first 24 hours. Signs can appear anywhere from 4 to 48 hours after a problem occurs.

Go to the emergency room or call your doctor right away if you notice new or worsening pain in the lower right part of your abdomen (upper right side for pregnant women).

It’s especially important to see a doctor if you also experience:

  • Fever.
  • Loss of appetite with nausea or vomiting.
  • Lack of energy.
  • Inability to pass gas.

Appendicitis has similar symptoms with some other conditions. So, it’s important to have a doctor determine what’s wrong, Dr. O’Brien says.

Symptoms can mimic:

  • Crohn’s disease.
  • Ulcerative colitis.
  • Gallbladder problems.
  • Urinary tract infections.
  • Pelvic inflammatory disease.
  • Stomach problems.
  • Intestinal blockages.

How do doctors diagnose appendicitis?

There’s no blood test to identify appendicitis. A blood sample can show an increase in your white blood cell count, which points to an infection.

Your doctor also may order an abdominal or pelvic CT scan or X-rays. Doctors typically use ultrasound to diagnose appendicitis in children.

What are your treatment options?

Doctors can treat appendicitis in two ways.

In less severe cases, your doctor may prescribe antibiotics. However, most appendicitis cases require surgery (an appendectomy) to remove the appendix.

If your appendix hasn’t burst, your doctor may remove it through a small cut in the belly button, a laparoscopy. This procedure works well for people of all ages. Recovery typically takes between two and four weeks.

A ruptured appendix will often require a longer recovery time. The surgeon will clean out any infection that’s spread in the abdomen and this can often be performed through a camera inserted through a small cut in the belly button as well.

The bottom line? Don’t hesitate to seek medical care if you notice potential signs of appendicitis, Dr. O’Brien says.

“Treatment has the best results if appendicitis is found early,” he says.

Overview

Appendicitis is a painful swelling and infection of the appendix. It is a medical emergency. The appendix can burst or rupture. This is serious and can lead to more infection. If not treated, it can be fatal.

The appendix is a thin, finger-shaped tube that is joined to the large intestine. It sits in the lower right part of the belly (abdomen). Experts don’t know for sure what role the appendix has in the body. It is not a vital organ. Removing it is not harmful.

Surgery to remove the appendix is called an appendectomy. It is the most common type of emergency surgery for children. Most children recover with no long-term problems.

Causes

Appendicitis happens when the inside of the appendix is blocked by something, causing an infection. The blockage may be caused by nose or mouth fluid, called mucus. It can also occur because of stool or parasites. Or the blockage may be caused by a bend or twist in the appendix itself.

The appendix then becomes sore and inflamed or swollen. This is because the germs (bacteria) in the appendix begin to increase quickly. As the swelling and soreness get worse, the blood supply to the appendix is cut off.

All parts of the body need the right amount of blood flow to stay healthy. When blood flow is reduced, the appendix starts to die. The appendix will burst or rupture as its walls start to get holes. These holes let stool, mucus, and other substances leak through and get inside the belly or abdomen. A serious infection called peritonitis may occur in the belly when the appendix bursts. If not treated, it can be fatal.

Risk Factors

Most cases of appendicitis happen between the ages of 10 and 30 years. Children with cystic fibrosis may have a greater risk. Having a family history of appendicitis may also increase a child’s risk for this condition.

Symptoms

Each child’s symptoms may vary. Below are some common symptoms of appendicitis.

Pain in the belly (abdomen) is the most common symptom. This pain:

  • May start in the area around the bellybutton, and move to the lower right-hand side of the belly. Or it may start in the lower right-hand side of the belly.
  • Often gets worse as time passes
  • May be worse when the child is moving, taking deep breaths, being touched, or coughing and sneezing
  • May be felt all over the belly if the appendix bursts

Other common symptoms include:

  • Upset stomach (nausea) and vomiting
  • Loss of appetite
  • Fever and chills
  • Changes in behavior
  • Trouble having a bowel movement (constipation)
  • Loose stool (diarrhea)
  • Swollen belly in younger children

Diagnosis

Your child’s healthcare provider will take a health history and do a physical exam. The provider may also order tests, including:

  • Abdominal ultrasound. This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It is used to see internal organs as they work.
  • CT scan. This imaging test uses both X-rays and computer technology to show detailed images of any part of the body. This includes the bones, muscles, fat, and organs. It is more detailed than a general X-ray.

Other tests may include:

  • Blood tests. These tests check for infection and inflammation. They can also see if there are any problems with other abdominal organs, such as the liver or pancreas.
  • Urine test. This test can tell if there is a bladder or kidney infection, which may have some of the same symptoms as appendicitis.

Symptoms of appendicitis may look like other health problems. Always see your child’s healthcare provider for a diagnosis.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. Appendicitis is a medical emergency. It is likely the appendix will burst and cause a serious, deadly infection. For this reason, your child’s healthcare provider will likely advise that your child have surgery to remove the appendix. Your child may be given antibiotics and fluids through an IV before surgery starts.

Surgery is the most common treatment for appendicitis. But for some children, the healthcare provider may give antibiotics instead of surgery.

The appendix may be removed in two ways:

  • Open or traditional surgery. Your child is given anesthesia. A cut or incision is made in the lower right-hand side of the belly. The surgeon finds the appendix and removes it. If the appendix has burst, a small tube or shunt may be placed to drain out pus and other fluids from the belly. The shunt will be taken out in a few days, when the surgeon feels the infection is gone.
  • Laparoscopic surgery. Your child is given anesthesia. This method uses a few small incisions and a camera called a laparoscope to look inside the belly. The surgical tools are placed through one or more small incisions. The laparoscope is put in through another incision. This method is not usually done if the appendix has already burst.

Interval appendectomy

Sometimes the appendix bursts, and a collection of infected fluid or pus (abscess) may form. If this happens and your child is stable, the provider may recommend not removing the appendix right away. Instead, the provider may want to treat the infection first and drain the infected fluid from the abscess. The appendix will be removed later. This delayed surgery is called an interval appendectomy.

For an interval appendectomy, your child may first have IV antibiotics. These are given through an IV tube called a PICC line, or a peripherally inserted central catheter. This is done for about 10 to 14 days. In addition, the provider may use CT or ultrasound-guided images to drain the abscess. Once the infection and inflammation are gone, your child will have surgery to remove the appendix about 6 to 8 weeks later.

After surgery

A child whose appendix ruptured will have to stay in the hospital longer than a child whose appendix was removed before it burst. Some children will need to take antibiotics by mouth for a certain period of time after they go home.

After surgery, your child will not be allowed to eat or drink anything for a certain period of time. This lets the intestine heal. During this time, fluids will be given by IV into the bloodstream. Your child will also have antibiotics and medicines to ease pain through the IV.

At some point, your child will be able to drink clear liquids such as water, sports drinks, or apple juice. He or she will slowly move on to solid foods.

After your child leaves the hospital, the healthcare provider will likely limit his or her activities. Your child should not do any heavy lifting or play contact sports for a few weeks after surgery. If a drain is still in place when your child goes home, he or she should not take a bath or go swimming until the drain is removed.

You will be given a prescription for pain medicine for your child to take at home. Some pain medicines can make a child constipated, so ask your healthcare provider or pharmacist about any side effects. Moving around after surgery rather than lying in bed can help prevent constipation. Drinking fruit juices may also help. Once your child can have solid foods again, eating fruits, whole grain cereals and breads, and vegetables can also help stop constipation.

Most children who have their appendix removed will have no long-term problems.

Complications

An irritated appendix can quickly turn into an infected and ruptured appendix. This can happen in a few hours. A ruptured appendix is an emergency situation. If not treated, it could be fatal. When the appendix ruptures, germs (bacteria) infect the organs inside the abdominal cavity. This causes a bacterial infection called peritonitis. The bacterial infection can spread very quickly. It may be hard to treat if diagnosis is delayed.

When to Call a Healthcare Provider

An infected appendix can burst or rupture. This is an emergency situation and could be fatal. If you think your child has appendicitis, call your child’s provider or go to the emergency room right away.

Key Points

  • Appendicitis is a painful swelling and infection of the appendix. It is a medical emergency.
  • The appendix can burst or rupture, causing more infection. If not treated, it can be fatal.
  • Healthcare providers will likely recommend that the child’s appendix be removed.
  • An appendectomy is the most common type of emergency surgery for children.
  • Most children recover with no long-term problems.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Symptoms


Appendicitis

When to get medical help

If you have abdominal pain that’s gradually getting worse, contact your GP or local out-of-hours service immediately.

If these options are not available, call NHS 111 for advice.

Appendicitis can easily be confused with something else, such as:

  • gastroenteritis
  • severe irritable bowel syndrome (IBS)
  • constipation
  • bladder or urine infections
  • Crohn’s disease
  • a pelvic infection

In women, symptoms similar to those of appendicitis can sometimes have a gynaecological cause, such as an ectopic pregnancy, menstrual pain or pelvic inflammatory disease (PID).

But any condition that causes constant abdominal pain requires urgent medical attention.

Call 999 to ask for an ambulance if you have pain that suddenly gets worse and spreads across your abdomen, or if your pain temporarily improves before getting worse again.

If your pain eases for a while but then gets worse, your appendix may have burst.

A burst appendix can cause peritonitis, which is a serious infection of the inner lining of the abdomen.

Find out more about the complications of appendicitis

Appendicitis means inflammation of the appendix – a small, finger-like pouch that comes out of the gut wall at the start of the large intestine.

Appendicitis can be life threatening – if you or someone else is suffering from severe symptoms, including intense tummy pain you may be at risk of a burst (or perforated) appendix, which requires urgent medical attention.

In most cases the reason why the appendix becomes inflamed is not known. It may be due to a blockage in the appendix. This may be due to faecal matter (poo) or indigestible food getting stuck there. This provides a rich breeding ground for bacteria to thrive, causing the appendix to become infected, swollen and full of pus.

The main symptom of appendicitis is tummy pain. As the inflammation gets worse, the pain increases and becomes very severe. Other symptoms may include:

  • fever
  • nausea
  • vomiting
  • diarrhoea.

At first, you may notice abdominal pain as a dull pain around the tummy button (naval).

As the inflammation worsens, the pain becomes sharper and may move down to the lower right-hand side of the abdomen, above where the appendix is normally located.

The pain rapidly worsens and over a 6 to 24 hour period can become severe.

The area around the site of the pain becomes very tender. If you gently pushed two fingers into your abdomen it would be very painful; the pain on releasing the fingers can be even worse.

Not all cases of appendicitis follow this ‘classic’ course. In some cases, the pain is felt higher in the tummy (particularly if you are pregnant) or closer to the back passage (anus). In other cases the pain is quite mild and does not become severe until the appendix bursts.

If your appendix bursts severe pain can spread to the whole abdomen. Your tummy will feel hard and tight, and you will not be able to push your fingers into it at all. Coughing and any movement, particularly of the legs at the hips, will be painful. The pain is caused by the entire lining of the abdomen (the peritoneum) becoming infected and inflamed. This is known as peritonitis.

If you have symptoms of appendicitis, your doctor may be able to diagnose what is wrong easily, based on your description of symptoms and a physical examination. Other times, this is difficult to do because there are many possible causes of abdominal pain and no simple test to be sure if it is appendicitis.

Therefore, to make a diagnosis, doctors use a range of tools which include:

  • Asking questions like” When did you first have this pain? Where does it hurt?”
  • Performing a physical examination to look for tenderness.
  • Blood tests looking at the white blood cell count for signs of infection.
  • Urine test to rule out urine infection, and women are usually offered pregnancy tests.
  • Sometimes an ultrasound may be used to help identify the cause of abdominal pain.

Treatment is normally an operation to remove the inflamed appendix before it bursts. This procedure is called an appendectomy.

Laparscopic appendectomy: In straightforward, non-complicated situations, surgeons will often perform the appendectomy through a laparoscopic technique, using very small holes and a video camera to remove the appendix without the need for a larger cut.

Open appendectomy: In more difficult cases, an “open” approach is performed, in which a slightly larger incision (cut) is made on the abdomen to remove the appendix. This surgery is generally combined with the use of antibiotics. How much and how often you have to take the antibiotics may vary, depending on the severity of your condition.

If the appendix has already ruptured, you will be admitted to hospital for close observation and given intravenous antibiotics. You may be given an “open” appendectomy to wash out the fluid contents that have leaked from the ruptured appendix.

Self-care

Once you have been discharged from hospital you need to:
Care for your incision site(s)

  • Keep the site clean, washing daily with gentle soap and water.
  • Your doctor will tell you when you may remove the dressing covering the incision site, this will normally be 48 hours after the operation
  • In some cases, small thin strips may be seen covering your incision once you have removed the bandage – these are longer-lasting bandages, and can be left in place until they begin to fall off on their own (generally in 1-2 weeks).

When to see your doctor again

  • You will usually have a follow-up visit 10-14 days after your surgery.
  • In the meantime, call your doctor immediately if any of the following symptoms develop:
    • fever
    • new redness spreading outward from your incision site
    • pus or other drainage from your incision
    • sudden onset of severe nausea/vomiting
    • new and worsening severe abdominal pain.

Activity limitations

  • Do not perform heavy lifting or strenuous activity until you have been seen at your checkup appointment
  • Ask your surgeon about when is safe to return to your regular job. This will depend on the type of work you do and whether your appendectomy was laparoscopic or open (see treatment above)

Pain control

  • In most cases, pain felt after surgery should be minimal after the first few days.
  • Your surgeon will provide you with a prescription for pain medication. Use this only if you are having pain that you would consider moderate to severe.

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An urgent laparoscopic appendectomy performed aboard the nuclear-powered aircraft carrier USS Enterprise (U.S. Navy via Wikimedia Commons)

First, the warning label for this story: A perforated appendix can kill you. If you experience symptoms of appendicitis, particularly sharp pain in the lower right area of your abdomen, get prompt medical care.

End of warning. Now for the surprising counter-example. You’ve seen acute appendicitis on hospital shows: The patient hunched over in unbearable stomach pain, rushed to the operating room for life-saving surgery to remove the organ gone awry. That’s the popular image of appendicitis, and it does reflect reality. Appendectomies are the most common emergency operation that general surgeons perform — at a rate of more than a quarter of a million a year.

But medicine is ever-evolving, and the thinking on appendectomies has been changing in recent years. Where once acute appendicitis meant an instant trip to the operating room, that call is now becoming somewhat more nuanced, and is likely to become still more refined in coming years.

Our case in point: WBUR’s news director, Martha Little. Her appendix has burst. And she’s been working in the newsroom this week as usual, burst appendix and all. No, this is not the ultimate workaholism. She explains:

A couple of weeks ago, I thought I had food poisoning. I came in to work late that Monday, but worked long days all the rest of that week with mild shooting pains across my upper intestines. I thought I had contracted some weird virus.

Then came the weekend. My kids, my husband and I went to Fairfield, Connecticut for a family reunion. After two days of whiffle ball and frolicking in the ocean I popped open a Phil’s Blackberry Cider, ate a brownie (I know, I eat like a kid) and got in to the lukewarm hot tub. About a half an hour later, I felt myself crumpling onto the front lawn with intense abdominal pain.

I thought it was gas. My brother-in-law Remi, who just happens to be a general practitioner, was packing up his family to go home. “Remi,” I said, “I’m actually in a lot of pain.” He palpated my abdomen and thought it might not be appendicitis because the pain was all over my lower abdomen, not just on the right side, and I had no fever, no vomiting.

I hauled myself into the house and lay on the couch in agony. Remi said that if it didn’t get better in a half hour, I should go to the emergency room. But with some Advil, it did get better. And after a hot bath, I felt really better, so we drove the two and a half hours back to Boston.

On Tuesday — because the doctor had no time on Monday — I got a CAT scan, blood tests and an X-ray. The CAT scan showed that there was, as the doctor put it, “something cooking” around my appendix and I should “get myself to the emergency room as soon as possible.” I didn’t panic. But I did wonder if I had only minutes to live.

After going to the wrong hospital, I finally made it to the Brigham & Women’s emergency room, where I was told I would likely have the appendix taken out that night. But upon further examination, the surgeon and his resident told me that I could wait eight weeks for surgery, and meanwhile they would treat the infection with serious antibiotics.

Eight weeks!? “What,” I said, “would happen if the appendix burst?”

“It has already burst,” they said.

What? I thought people died when their appendix burst.

No, I was told. Not always.

The body, they explained, has a way of “walling off” the perforated appendix so that the infection doesn’t spread. I asked another of the four surgeons who visited me in the acute care ward: How much time does one normally have? That is, until one dies from a peritoneal infection?

After our conversation, I realized he had never answered that question. He said: You would have known it was serious when your stomach muscles contracted so much it looked like a washboard. I wisecracked, “How could I distinguish that from my normal state?” He forced a laugh.

I am now on massive doses of the antibiotics Cipro and Flagyl, and staying away from alcohol. I have also read that heating pads and hot baths are not necessarily good for you when you have appendicitis. But I wonder if the water of the bath I took helped take the pressure off and slowed the infection. Who knows? All I know is that these days, if the burst appendix doesn’t kill you, they wait until the infection goes away and then take the thing out laparoscopically, in a same-day turnaround operation.

Wow, I said to Martha. Some people get “walking pneumonia.” You have “walking appendicitis.”

But I was gently corrected by Dr. Douglas S. Smink, program director of the general surgery residency program at Brigham & Women’s Hospital. While “walking pneumonia,” which is not a medical term, tends to be a milder form of the illness, there’s nothing mild about appendicitis that has already reached the point that it has perforated the appendix. In fact, he said, it’s more severe. In the United States, perhaps 80 percent of appendicitis cases get to surgery before the organ ruptures.

The appendix marked in red (Olek Remesz, Wikimedia)

(A brief tangent: I suddenly realized that I could not picture a “perforated appendix.” Was it like a water balloon exploding? A cardboard box torn along its perforations? Dr. Smink explained: The appendix, which is about the size and shape of a pinky finger, gets very inflamed until, in one area, its muscular wall gets so thin that it breaks open, releasing the bacteria-laden fluid inside. But the fluid doesn’t explode out like a splatting water balloon; it seeps and oozes out as if the balloon had sprung a leak.)

Here’s the good news for patients like Martha: The appendix is surrounded by other structures, mostly the intestine, and so, as she was told, the seepage can get “walled off.” One theory, Dr. Smink said, is that a somewhat mobile layer of visceral fat called the omentum — nicknamed “the policeman of the abdomen” — could be drawn toward areas of inflammation to contain infection. So a patient can end up with a pus-filled abscess outside the appendix, covered partially by the omentum.

Still, why not just operate and get rid of the problem? It’s not so simple. An area rife with inflammation is hard for surgeons to work with, Dr. Smink said, and an appendectomy could end up turning into removal of part of the intestine and colon as well.

So the idea is to give the patient antibiotics to fight the infection, wait as the inflammation subsides and then do an “interval appendectomy,” after the waiting interval. (And by the way, even emergency appendectomies are done promptly but not with quite the urgency of old; waiting several hours appears to do no harm.)

A 1940s appendicitis poster (U.S. National Archives and Records Administration via Wikimedia Commons)

Twenty years ago, Dr. Smink said, surgeons would go in and operate on virtually all cases of appendicitis, whatever the level of inflammation. But research found that for a certain group of patients, it was better to wait. Now, even the “interval appendectomy” is becoming controversial; a newer school of thought holds that some patients may do best with antibiotics alone, no operation at all.

The problem right now, he said, is that there’s some data on the antibiotics-only strategy, but not enough to make clear which patients really need an appendectomy and which can get along without one. Patients who have a stone in the appendix, called an appendicolith, definitely need the organ removed, for example, but many other cases are not so clear cut. More research is needed, he said, to explore the effects of age, severity of illness and other factors on whether antibiotics-only treatment will work for a given patient.

Meanwhile, some studies also suggest that for many patients with uncomplicated appendicitis — the appendix still intact — antibiotic treatment alone may be enough as well. (I’m imagining myself as a patient with high-deductible insurance. That might pose quite a dilemma: Try just antibiotics, or take the safe but expensive route straight to the OR?)

Why are treatments for appendicitis evolving so notably away from the operating room? The general trend in surgery is that the less invasive, the better, Dr. Smink said. That’s also why more than half of appendectomies are done laparoscopically — through a tiny incision — these days. And better research leads to a better understanding of the outcomes of treatments.

Bottom line: If Martha’s appendix had blown 20 years ago, it would have long since been removed, possibly along with other parts of her. If it blew twenty years in the future, she might not end up having any appendectomy at all. You’re part of medical history, I told her.

She didn’t look very excited.

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