Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10 cm (2 to 4 inches) long. It’s connected to the large intestine.
Nobody knows exactly what the appendix does, but removing it is not harmful.
Symptoms of appendicitis
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 make the pain worse.
You may lose your appetite, have vomiting and have constipation or diarrhoea.
When to get medical help
If you have abdominal pain that’s gradually getting worse, contact a surgeon or nearby hospital’s emergency department
If your pain eases for a while but then gets worse, your appendix may have burst, which can lead to life-threatening complications.
How appendicitis is treated
If you have appendicitis, it’s likely your appendix will need to be removed as soon as possible.
Removal of the appendix, known as an appendicectomy or appendectomy, is 1 of the most common operations and its success rate is excellent.
Surgery is often also recommended if there’s a chance you have appendicitis but it’s not been possible to make a clear diagnosis.
This is because it’s considered safer to remove the appendix than risk it bursting.
In humans, the appendix does not perform any important function and removing it does not cause any long-term problems.
Appendicectomy (appendectomy)
Removal of the appendix is carried out under general anaesthetic using either keyhole or open surgery.
Keyhole surgery
Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery.
The operation involves making 3 or 4 small cuts (incisions) in your tummy (abdomen).
Special instruments are inserted, including:
- A tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work
- A laparoscope – a small tube with a light and a camera, which relays images of the inside of the abdomen to a television monitor
- Small surgical tools used to remove the appendix
After your appendix has been removed, dissolvable stitches may be used to close the incisions.
If regular stitches are used, they’ll need to be removed 7 to 10 days later.
Open surgery
In some circumstances, keyhole surgery is not recommended and open surgery is used instead.
These include:
- When the appendix has already burst and formed a lump called an appendix mass
- When the surgeon is not experienced in laparoscopic removal
- People who have previously had open abdominal surgery
In open surgery, a single larger cut is made in the lower right-hand side of the abdomen to remove the appendix.
When there’s widespread infection of the inner lining of the abdomen (peritonitis), it’s sometimes necessary to operate through a cut along the middle of the abdomen. This procedure is called a laparotomy.
As with keyhole surgery, the incision is closed using either dissolvable stitches or regular stitches that need to be removed at a later date.
After both types of surgery, the removed appendix is sent to a laboratory to check for signs of cancer.
This is a precautionary measure and it’s rare for a serious problem to be found.
Recovery
One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation.
If the procedure is carried out promptly, you may be able to go home within 24 hours.
With open or complicated surgery (for example, if you have peritonitis) it may take up to a week before you’re well enough to go home.
For the first few days after the operation it’s likely you’ll have some pain and bruising. This improves over time, but you can take painkillers if necessary.
If you have had keyhole surgery, you may have pain in the tip of your shoulder for about a week.
This is caused by the gas that was pumped into your abdomen during the operation.
You may also have constipation for a short period after the operation.
To help reduce this, eat plenty of fibre, and drink plenty of fluids.
Before leaving hospital, you’ll be advised about caring for your wound and what activities you should avoid.
You should be able to return to normal activities in a couple of weeks, although you may need to avoid more strenuous activities for 4 to 6 weeks after open surgery.
Your surgeon should discuss this with you.
What causes appendicitis?
It’s not clear what causes appendicitis. In many cases it may be that something blocks the entrance of the appendix.
For example, it could become blocked by a small piece of stool, or an upper respiratory tract infection could cause the lymph node within the wall of the bowel to become swollen.
If the obstruction causes inflammation and swelling, it could lead to increased pressure within the appendix, which may then burst.
As the causes of appendicitis are not fully understood, there’s no guaranteed way of preventing it.
Who’s affected
Appendicitis is a common condition. You can get appendicitis at any age, but it usually affects young people aged between 10 and 20 years.