Conditions Acute appendicitis

Strictly speaking, in acute appendicitis it is not the cecum (the first part of the large intestine) that is inflamed, but the vermiform appendix – a tube lined with mucous membrane on the inside that hangs like a small worm from the end of the cecum. The medical term for this is the “vermiform appendix”. If the appendix wall becomes inflamed, this often causes severe abdominal pain.

The inflammation can result in the formation of pus and the purulent inflammation can spread to neighboring tissue. In a rupture (perforation), pus, wound fluid, and bacteria enter the abdominal cavity. This requires prompt treatment to prevent life-threatening complications. This is why most cases of acute appendicitis are quickly treated with surgery.

Appendicitis usually starts with pain, often in the upper abdomen or around the naval (belly button).

This is later followed by other symptoms such as:

• severe pain, typically in the lower right abdomen
• loss of appetite
• nausea and vomiting
• constipation or sometimes even diarrhea
• fever

With some people, the symptoms are not as typical or are only mild in nature: pregnant women often experience pain in the upper abdomen while children and older people sometimes only experience mild pain.

Not everybody’s appendix is in the same place. Sometimes it is located more towards the person’s back but it may also protrude further into the pelvis. As a result, non-typical abdominal pain or discomfort when urinating may also occur.

A medical examination is always advisable if abdominal pain persists for several hours.

An exact cause of appendicitis is not known. Experts believe that an inflammation can occur if the appendix becomes kinked, or if hardened stool or parasites (worms) get inside.

The appendix may also become inflamed because many immune cells are located there and the tissue becomes inflamed as part of a general immune response.

Appendicitis is one of the most common acute diseases of the abdominal cavity that require treatment. Appendicitis can occur at any age, but especially in childhood and adolescence.

About 7 percent of girls and women and nearly 9 percent of boys and men get an inflamed appendix during their lives. Approximately one in 1,000 people develop appendicitis every year. In Germany, over 135,000 appendectomies are performed annually.

Appendicitis usually occurs suddenly and causes symptoms such as pain, nausea, or a high temperature. The pain often begins in the upper abdomen, increases within a few hours and shifts to the lower right abdomen.

Specialists distinguish between different types of the condition:

• Uncomplicated appendicitis – the appendix is merely inflamed. It is now believed that this form can also subside on its own. However, the appendix is usually surgically removed to prevent the inflammation from progressing and to avoid a complicated course.
• Complicated appendicitis – this causes pus to form, which can collect, for example, in a pus-filled cavity (abscess). The purulent inflammation can spread to neighboring tissue and destroy the appendix. In a rupture (perforation), pus, wound fluid, and bacteria enter the abdominal cavity. A hard abdominal wall, a doubled-over posture, pallor, an accelerated pulse and light-headedness can all be indications of a ruptured appendix. Prompt treatment is required to prevent possible life-threatening complications.

About 2 to 3 out of 10 cases of appendicitis are complicated. Children and older people have an increased risk of a complicated course. If complicated appendicitis is not treated promptly, this increases the risk of life-threatening circulatory problems and sepsis (commonly known as “blood poisoning”).

It is often difficult to identify appendicitis because the symptoms can vary so much. The doctor will first ask exactly where the stomach hurts and whether there are any other symptoms such as a fever, constipation or vomiting. The doctor will perform a physical examination to identify any other signs of appendicitis. This involves feeling the person’s abdomen. If pressing on certain areas of the stomach is particularly painful, this indicates appendicitis or peritonitis.

Many other abdominal and pelvic diseases cause abdominal pain similar to appendicitis, for example, inflammation of other parts of the intestine or diseases of the bladder or sex organs.

As there are no physical signs that clearly indicate appendicitis, further examinations often follow:

• a blood sample to measure inflammatory markers in the blood
• an ultrasound examination to detect changes to the appendix or the formation of pus
• sometimes a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to identify appendicitis and rule out other conditions

In most cases, once the condition has been diagnosed, the inflamed appendix is removed within 24 hours through a minimally invasive procedure (laparoscopy). During this procedure, the necessary instruments and a camera are inserted into the abdominal cavity and operated through thin tubes. The inflamed tissue is also removed using this method. Sometimes, open surgery is used for appendicitis – for example, when the inflammation is already spreading. This requires making a larger incision in the abdominal wall.

Doctors can sometimes treat uncomplicated appendicitis with antibiotics instead of surgery. This also usually allows the inflammation to subside without complications. However, there is an increased risk that the appendix will become inflamed again and need surgery after all. If abscesses have already formed, treatment with antibiotics is sometimes still possible and surgery can be postponed for the time being. Then a thin tube (drain) is additionally placed in the abdominal cavity through which the pus drains. However, in most cases of complicated appendicitis, rapid surgical intervention is recommended.

More detailed information about surgically removing an inflamed appendix can be found at gesundheitsinformation.de.