Patient information from BMJ


Appendicitis

Last published: Feb 09, 2021

Having appendicitis can be painful and worrying. You'll probably need an operation. But most people recover completely and don't have any problems afterwards.

We've brought together the best and most up-to-date research about appendicitis to see what treatments work. You can use our information to talk to your doctor and decide which treatments are best for you.

What is appendicitis?

If you have appendicitis it means your appendix is inflamed or infected. Your appendix is a small tube of tissue in the lower right part of your bowels (intestines). Small pieces of partly digested food, or fluid in your intestines can get stuck in your appendix and cause an infection.

What are the symptoms?

The first sign is usually pain in your abdomen. After a few hours the pain may travel to the right side of your lower abdomen. The pain may be worse if you move, and it might get a little better if you draw your knees up.

You probably won't feel like eating, and you might vomit. You may also have a slight fever and possibly have constipation or diarrhoea. Not everyone with appendicitis gets all these symptoms.

It's very important to see a doctor urgently if it's possible that you have appendicitis. If you don't get treatment your appendix can burst. This can cause a serious infection called peritonitis.

A burst appendix is more common in babies, young children, and older people. That’s because appendicitis is harder for doctors to spot in children and older people.

How do doctors diagnose it?

If you have some of the symptoms mentioned above, this should strongly suggest to a doctor that you might have appendicitis. But there are tests they can do to make sure.

For example, you might have a CT (computerised tomography) scan. This type of scan uses x-rays to look at your internal organs. It can spot if your appendix is inflamed. You will probably also have blood tests.

What treatments work?

Surgery

If you have appendicitis you'll probably need surgery to take out your appendix. A burst appendix is also treated with surgery.

There are two types of surgery for appendicitis. If you have open surgery your surgeon takes out your appendix through one cut in the lower right part of your abdomen.

Or there's keyhole surgery, which is also called laparoscopic surgery. That's where the surgeon makes several smaller cuts and does the operation through these with the help of a camera.

People who have keyhole surgery are less likely to get an infection or other complications after the operation. They also have less pain and are able to go home from hospital sooner.

But keyhole surgery is not available everywhere. It takes a long time for a surgeon to become expert at this type of operation, so not all surgeons are trained in this type of surgery.

As well as the surgeon's experience, other things that might affect which type of surgery someone has include:

  • Being pregnant
  • Being obese (very overweight)
  • Having had previous surgeries, and
  • Being a child.

Whichever type of surgery you have, you'll have a general anaesthetic to make you sleep during the operation, so you won't feel any pain. After your operation the surgeon will close the cut or cuts on your abdomen with stitches or clips. You'll have these taken out after a few days. You'll have a scar but this may fade slowly over time.

You may have some pain after your operation. You'll be given painkillers to help with this. If your painkillers don't work, tell a doctor or nurse. They might be able to give you different painkillers or a larger dose.

Antibiotics with surgery

You'll be given antibiotics to prevent infections after surgery. This reduces the chance of you getting an infection soon after the operation. But some people still get an infection even if they have antibiotics.

Doctors give antibiotics as a drip (also called an intravenous infusion or IV). You may need to carry on having antibiotics for a few days after surgery.

Antibiotics can have side effects in some people. You may get pain where the drip goes into your body (this will probably be the back of your hand). Some people feel sick or get diarrhoea with certain antibiotics. And some people can have an allergic reaction to some of them.

If you are too ill to have surgery immediately

Some people aren't healthy enough to have surgery straight away. This may be because the infection in your appendix has already spread, and you might need treatment with antibiotics for several weeks before you can have an operation.

If an abscess has formed you will probably need to have this drained. An abscess is a build-up of pus. It is usually drained just using a needle. The doctor uses a CT image to help guide the needle.

Antibiotics help reduce the pain from appendicitis. You'll probably start by having antibiotics as a drip. You may switch to tablets when you're well enough to eat.

You may be well enough to leave hospital after a couple of days. But you will need to go back into hospital when you are well enough to have your appendix taken out, usually after about six weeks.

For some people who can't have surgery straight away, antibiotics (and possibly abscess drainage) are the only treatment they need. They don't need to have their appendix removed. But this is rare.

Treatment without surgery

Some recent research has suggested that, for some people with appendicitis, antibiotics might be the only treatment they need.

However, more research would need to show that this approach is safe before it could become standard practice. Most doctors are highly unlikely to suggest this approach for the moment.

What will happen to me?

As with any type of operation, surgery for appendicitis carries risks, such as an infection. But most people recover very well. You can live quite happily without your appendix. You'll probably go home from hospital within a few days.

You should be able to start eating normally again a day or two after the operation. But you should take at least a week off work or school to give yourself time to recover.

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