Patient information from BMJ


Appendicitis

Last published:Aug 05, 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 afterward.

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.

Other symptoms can include:

  • loss of appetite

  • vomiting

  • a slight fever, and

  • constipation or diarrhea.

But 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 (computerized 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 are available?

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 the 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 anesthetic 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 might have some pain after your operation. You'll be given pain relievers to help with this. If your pain relievers don't work, tell a doctor or nurse. They might be able to give you different pain relievers 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 an intravenous infusion (IV). You might need to carry on having antibiotics for a few days after surgery.

Antibiotics can have side effects in some people. For example, some people feel nauseous or get diarrhea with certain antibiotics. And some people can have an allergic reaction to some of them.

If you are too sick to have surgery immediately

Some people aren't healthy enough to have surgery right 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 an IV. You might switch to pills when you're well enough to eat.

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

Some people who can't have surgery right away don't need to have their appendix removed if they can have the abscess drained and they get better with antibiotics. But this is rare.

Treatment without surgery

For some people with appendicitis, antibiotics might be the only treatment they need.

This is more likely if you have what's called uncomplicated appendicitis. This means that the infection and inflammation are mainly in the appendix, and have not spread into other tissues or into the blood.

What to expect in the future?

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 the 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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