Appendicitis

What is appendicitis?

Appendicitis is due to inflammation and infection of the appendix, which, as a result, becomes swollen and can rupture (burst).

Appendicitis should never be treated lightly, as a severe infection and possible rupturing of the appendix can inflame and infect the whole of the abdominal wall (peritonitis) and have very serious and life-threatening consequences.

The appendix is a small, tubular appendage that is about 9cm which is attached at the cecum, the start of the colon (large intestine).

Facts about appendicitis

• The appendix is part of the lymphatic system and contains lymphatic tissue
• During adolescence, the appendix has an important role in maturing B cells, the white blood cells which are also known as lymphocytes and also in producing the antibody immunoglobulin A (IgA)
• In the unborn foetus, the appendix contains endocrine cells that make hormones and other substances necessary for development
• Appendicitis mostly occurs in children and young adults aged between 10 – 30 years
• Appendicitis is rare in young children, especially in those under 2 years
• Appendicitis is the most common emergency abdominal surgery for children and younger adults

Symptoms of appendicitis

Chronic appendicitis

Symptoms of chronic appendicitis include:

• Abdominal pain – this is normally the first (and sometimes main) symptom
• Diarrhoea
• Loss of appetite
• Low grade fever
• Nausea
• Swelling of the abdomen
• Vomiting

Acute appendicitis

Acute appendicitis occurs when the appendix is severely infected and inflamed and as a result of this, ruptures (or bursts). If this occurs, the the faecal matter in the appendix can contaminate the abdominal cavity and cause peritonitis.

Peritonitis is a very serious and life-threatening situation and needs urgent medical attention. Call an ambulance 000.

The symptoms of acute appendicitis are the same as chronic appendicitis, just more severe.

Anyone who experiences progressively worsening abdominal pain needs to seek urgent medical attention.

Causes of appendicitis

While it is not known definitively what exactly causes appendicitis, a few theories have been proposed.

Infection

One possible cause of appendicitis is a recent infection in some part of the digestive system (stomach or small intestine) and the virus or bacteria from this infection then travels to the appendix and infects it too, so that it becomes inflamed and infected. Another possibility is an infection from another part of the body that travels to the appendix and infects it too.

Obstruction

Another possible cause of appendicitis is the theory that some faeces could get stuck in the appendix and this can cause it to get inflamed, irritated and infected when the bacteria that are inside the faeces multiply within the small confines of the appendix. In addition to faeces, other theories for obstruction include parasites and certain growths that can also occur within the appendix and cause the same inflammation and infection.

Inflammatory Bowel Disease

Another theory proposed is that inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) can cause inflammation of the bowels and possibility of obstruction and abscess of any part of the bowel (including the appendix). This is linked to a low fibre diet.

Injury to the bowel

If the bowel (colon) experiences an injury or trauma in some way, at the point where the appendix sits, this could cause the appendix to become inflamed and irritated.

Prevention of appendicitis

Non-preventable risk factors

Appendicitis may be unpreventable in certain circumstances:

• Age – children and young adults are more likely to experience appendicitis, with the risk factor highest in those who are aged between 10-30. The reason for this is not known
• Infection – a recent infection, especially if it occurs in the gastrointestinal system is a known risk factor for increasing likelihood of infection of the appendix and subsequent appendicitis
• Injury – any injury to the abdominal area near the appendix has the potential to cause it to be inflamed and likely to rupture, if the trauma is severe enough
• Recent infection – it is well known that the risk for appendicitis, especially in children and younger adults, can be much higher after a recent infection in the digestive system (or other part of the body) which travels to the appendix to cause it to be infected and inflamed
• Trauma to the appendix – if the appendix has been injured in some way (through an accident of some sort that causes internal injuries), this can also increase risk for appendicitis where the appendix becomes very inflamed and swollen and risk for rupture also increases

Preventable risk factors

There are some medical experts who think that proper digestion is a possible way to prevent appendicitis (especially the mild form) from occurring.

• Low fibre diet – a low fibre diet is linked to many digestive disorders that can increase risk of appendicitis. A low fibre diet especially increases risk for constipation and this can cause some of the faecal matter to become lodged in the appendix and cause appendicitis. A healthy diet, rich in fibre from vegetables, fruit, wholegrains and legumes is vital for a healthy digestive system and to prevent various digestive disorders. Studies show that people whose diet is high in fibre have lower incidence of appendicitis
• Obstruction – an obstruction in the bowel (colon) or improper working bowel can lead to obstruction in the appendix. If the faecal matter does not move past the appendix, it can get stuck in it. Obstruction is generally linked to a poor diet, which is low in fibre, although some cases of obstruction may not be caused by poor diet

Complications of appendicitis

The main complication of appendicitis is when very inflamed and infected appendix ruptures (or bursts). If this occurs, the the faecal matter in the appendix can contaminate the abdominal cavity and cause peritonitis.

Peritonitis is a very serious and life-threatening situation and needs urgent medical attention. Call an ambulance 000.

If there are complications, (the appendix bursts, or other things go wrong during surgery), the patient will be advised to stay in hospital longer to rule out any subsequent infections.

People who have any of the symptoms of appendicitis need to seek medical attention to get a medical diagnosis to rule out appendicitis, as it can be fatal if it is acute and is not promptly treated.

When to see a doctor about appendicitis

A doctor should be consulted if any of the symptoms of appendicitis occur, especially if the pain is unabating and severe.

Appendicitis can be potentially life threatening (if the appendix ruptures), so always seek emergency treatment if there are symptoms of appendicitis.

Diagnosis of appendicitis

Appendicitis has such similar symptoms to other conditions affecting the abdominal organs, it can be a challenge to diagnose it.

To confirm appendicitis (or rule it out), the doctor will perform the following initial tests:

• Medical history – the doctor will ask some questions about the onset of symptoms, the type of symptoms and where the pain emanates from in the stomach area
• Physical examination – the doctor will examine the abdomen for pain and tenderness, particularly from where the pains originate
• Observation – if the symptoms are not too severe (or they dissipate), the doctor may recommend observation to determine if the pain returns or improves

Other tests

In addition to the initial tests, the following tests can also be performed:

• Blood test – a blood test can determine if there is an infection in the body, which can be identified if the white blood cell numbers are elevated
• Urine test – this is a simple test to help rule out conditions such as a bladder and kidney infections or urinary tract infections (UTIs), which can present with the same symptoms
• CT scan – this is sometimes performed to have a closer look at the appendix, to see if it is inflamed and swollen, which is an indication of infection (but this is not usually performed in an emergency situation where surgery is the only option after examination)

Conventional treatment of appendicitis

There are a few approaches to treating appendicitis, depending on severity and duration of symptoms.

Observation

If the symptoms are not too severe (or they dissipate), the doctor may recommend observation to determine if the pain returns or improves. Observation is mostly done at hospital, where emergency treatment (surgery) can be performed if symptoms increase dramatically and/or the appendix ruptures.

Medication

If the appendicitis is mild and is determined to be caused by an infection, the following medications can be prescribed:

• Antibiotics – the doctor may prescribe antibiotics to reduce the bacterial infection which is the source of the appendicitis
• Pain killers – the doctor may prescribe over-the-counter (or prescription) pain killing medication to reduce the severity of the pain

Surgery

If it is determined that it is appendicitis and especially if the appendix is very inflamed or infected and has the potential to rupture, then the doctor may decide to remove the appendix as a precautionary measure (to prevent possible complications of a ruptured appendix).

There are two types of surgery that can be performed, depending on a number of factors:

• Laparoscopic appendectomy – this is a newer type of surgery for removal of an appendix, which is known as keyhole surgery, as it enables the surgeon to make smaller incisions in the abdomen in which a thin tube with a camera and light are inserted. This allows the surgeon to view the appendix (and surrounding tissue) and remove it. A laparoscopic appendectomy requires less time in hospital for recovery (only a few days), leaves less scarring and is the preferable surgery for removing an infected appendix
• Traditional appendectomy – a traditional appendectomy requires a larger incision (cut) in the abdomen, leaves a bigger scar and requires a stay of up to a week in hospital to recuperate from the surgery. This type of surgery is usually recommended in the following circumstances:
  • the appendix has burst and an emergency procedure is required
  • women who are in their first trimester of pregnancy
  • people who have had any type of previous abdominal surgery, especially if it has been performed more than once
  • people who have existing tumours in their digestive system

Whatever type of surgery is performed, it may still take up to a few weeks to completely heal from the surgery after leaving hospital.

Alternative / complementary treatment of appendicitis

Appendicitis can be a serious and potentially life-threatening condition which requires urgent medical attention for diagnosis and treatment.

Do not try to treat suspected appendicitis with any alternative / complementary therapy – seek urgent medical advice

The information contained within this section is to be used only in cases of very mild appendicitis or to support healing after an appendectomy. Always seek medical advice to ensure it is safe to take these supplements.

Herbs

• Aloe vera – the cold pressed juice of the whole leaf of the aloe vera plant, has a number of beneficial properties for the gastrointestinal system, including limiting “bad” bacteria in the colon, increasing conditions for “good” bacteria, reducing risk of infection and improving colon health in general
• Echinacea purpurea – this herb has immune enhancing properties for the whole of the immune system. Echinacea has anti-viral, anti-bacterial and anti-fungal properties, which means it may be able to prevent infection by these pathogens
• Slippery elm (Ulmus fulva) – the herb slippery elm has mucilaginous properties, which means it coats the gastrointestinal tract with its soothing properties and relieves any inflammation. Some studies suggest that slippery elm may also contain some antioxidants, which help to boost the function of the immune system. People with any type of bowel blockage need to seek medical advice prior to trying slippery elm, as it could make their condition worse

Vitamins

• Betacarotene – the antioxidant vitamin betacarotene greatly enhances immunity and protects against further infection
• Vitamin A – the potent antioxidant vitamin A supports the immune system and protects against further infection
• Vitamin B – a vitamin B complex is recommended as it supports the immune system, supports the function of the antioxidant vitamins and helps the body absorb nutrients more effectively
• Vitamin C – the potent antioxidant vitamin C helps to boost the function of the immune system and helps to protect the body against infection. Vitamin C also helps to detoxify the system by allowing them to be removed through the liver
• Vitamin E – the potent antioxidant vitamin E helps to greatly boost the function of the immune system and white blood cells. Vitamin E promotes healing of all body tissues and cells

Minerals

• Zinc – the mineral zinc is an excellent antioxidant which greatly boosts the immune system and promotes healing of all body tissues and cells to occur more quickly

Other supplements

• Chlorophyll – this is the substance which gives plants their green colouring and also makes food for the plant. Chlorophyll may assist with clearing the blood of toxins and may help speed up healing. Try to get chlorophyll in its liquid form, as it is more effective

Dietary modifications

• Add more fibre – fibre is necessary in our diet, to help the colon function more effectively. Many studies show that people who have a fibre-rich diet have less incidence of appendicitis
• Reduce processed foods – food which is natural and unprocessed tends to be more richer in nutrients, have higher levels of fibre and is better for you

Lifestyle modifications

There are no lifestyle modifications recommended for appendicitis.

Alternative treatments

There are no other alternative treatments recommended for appendicitis.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with appendicitis

If the appendicitis is mild, there are a few strategies that can be used to reduce symptoms and prevent further inflammation:

• High fibre diet – studies show that a diet high in fibre greatly reduce risk of appendicitis from occurring in the first place. A diet high in fibre includes plenty of vegetables (especially leafy green vegetables), fruits, legumes, wholegrains and cereals. Adults need to ensure they get about 30g of fibre in their diet every day

Post-operative care after surgery

If the appendicitis requires surgery, then post operative care may require the following strategies to aid recovery:

• Diet – the surgeon will recommend a special diet for 1-2 weeks after the surgery to make it easier on the gastrointestinal system to digest food after the surgery, in order to assist in the healing the colon from where the appendix was removed
• Medication – the surgeon may also recommend some medication to take to prevent possibility of infection after the surgery (antibiotics) and also painkillers for any pain that may ensue
• Rest – in order for the abdominal wall incision to heal (especially if it is was from a traditional appendectomy) rest is recommended with no lifting for some time after the surgery (up to two weeks, but the surgeon will recommend a timeframe based on the severity of symptoms, the surgery and how serious it was)

Caring for someone with appendicitis

Parents

If your child has appendicitis, you can care for them through the following strategies:

• Healthy diet – in general, ensure your child has a diet which is rich in fibre and unprocessed foods to try to reduce risk of appendicitis occurring in the first place. A healthy diet includes a number of servings of vegetables, fruit, legumes, wholegrains, fish, protein and healthy fats
• Take them to the doctor – if a child experiences any abdominal pain, always seek medical advice from a family doctor. If the pain is very severe and the child has severe symptoms of suspected appendicitis, call an ambulance on 000
• Recuperation from surgery – if your child undergoes surgery, especially an emergency appendectomy, they will need to spend some weeks after the surgery healing. Your doctor will recommend a specific course of action for post-operative care, including medication and activity levels
• Inform the school – in addition to your care post surgery, you will also need to inform you child’s school so that they can provide an amount of school work at the doctors directions so that the child does not fall behind in their studies

Partner

If your partner has appendicitis, you can support them with the following strategies:

• Healthy diet – in general, ensure both you and your partner have a diet which is rich in fibre and unprocessed foods to try to reduce risk of appendicitis occurring in the first place. A healthy diet includes a number of servings of vegetables, fruit, legumes, wholegrains, fish, protein and healthy fats
• Take them to the doctor – if your partner experiences any abdominal pain, always seek medical advice from a family doctor. If the pain is very severe and your partner has severe symptoms of suspected appendicitis, call an ambulance on 000
• Recuperation from surgery – if your partner undergoes surgery, especially an emergency appendectomy, they will need to spend some weeks after the surgery healing. Your doctor will recommend a specific course of action for post-operative care, including medication and activity levels

Friends

If you have a friend who has appendicitis, you can support them with the following strategies:

• Support – if your friend’s appendicitis needs any type of surgery to remove the appendix, your friend will need to recuperate after surgery for some time (up to a few weeks), so it would be very supportive to visit them after the surgery

References

Last reviewed and updated: 14 May 2024