Understanding appendicitis

Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5-10cm (2-4 inches) long. It’s connected to the large intestine, where stools (faeces) are formed.

Nobody knows exactly why we have an appendix, but removing it isn’t harmful. Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.

Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally experience diarrhoea.

Complications of appendicitis
If appendicitis isn’t treated, the appendix can burst and cause potentially life-threatening infections.
Peritonitis: If your appendix bursts, it releases bacteria into other parts of the body. This can cause a condition called peritonitis if the infection spreads to the peritoneum, the thin layer of tissue those lines the inside of the abdomen.

Symptoms of peritonitis can include: severe continuous abdominal pain, feeling sick or being sick, a high temperature (fever), a rapid heartbeat, shortness of breath with rapid breathing, swelling of the abdomen

If peritonitis isn’t treated immediately, it can cause long-term problems and may even be fatal. Treatment for peritonitis usually involves antibiotics and the surgical removal of the appendix (appendectomy).

Abscesses: Sometimes an abscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the body’s attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about one in 500 cases.

Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus needs to be drained from the abscess. This can be carried out under ultrasound or computerised tomography (CT) guidance using local anaesthetic and a needle inserted through the skin, followed by the placement of a drain.

If an abscess is found during surgery, the area is carefully washed out and a course of antibiotics is given.

When to get medical help: These are signs your appendix may have burst, which can lead to potentially life-threatening complications.

How appendicitis is treated
In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendectomy, is one of the most common operations in the UK and its success rate is excellent.

The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted.

Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult.

Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6 weeks after open surgery.

What causes appendicitis?
It s not exactly clear what the causes of appendicitis are. Most cases are thought to occur when something blocks the entrance of the appendix.

For example, a blockage may be formed by a small piece of faeces or an upper respiratory tract infection could lead to a swollen lymph node within the wall of the bowel.

This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting.

As the causes aren’t fully understood, there’s no guaranteed way of preventing appendicitis.

Who’s affected?
Appendicitis is a common condition. Around 40,000 people are admitted to hospital with appendicitis each year in England. It is estimated around 1 in every 13 people develop it at some point in their life.

Appendicitis can develop at any age, but it is most common in young people aged from 10 to 20 years old.
*Dr. Anthony Nwaoney is an epidemiologist