The appendix is a narrow finger-like projection connected to the caecum, the first portion of the large intestine (colon). Appendicitis refers to inflammation of the appendix. Although the exact cause of appendicitis is not known, it is believed that a blockage in the lumen of the appendix causes bacteria to multiply, resulting in the appendix becoming swollen and filled with pus.
Appendicitis can occur at any age, but it is more common between the ages of 10 to 30.
Symptoms of appendicitis may include:
- Pain in the right side of the lower abdomen
- Pain that begins in the abdomen and subsequently moves to the right side of the lower abdomen
- Nausea and vomiting
- Loss of appetite
- Rupture of the appendix
- Development of an abscess (walled off pocket of pus) in the abdomen
Clinical examination by a doctor
There may be tenderness when the doctor applies pressure in the right lower abdomen. This may be worse when the pressure is suddenly released, indicating that the adjacent peritoneum is inflamed.
Computed Tomography (CT) scan
This is the most common investigation performed for the diagnosis of appendicitis. A swollen or fluid filled appendix is diagnostic of appendicitis. There may also be free fluid/pus seen in the abdomen if the appendix has ruptured.
An ultrasound scan may be performed in children as there may be concerns of radiation associated with CT scans.
What is the treatment for appendicitis?
This usually involves surgery (appendicectomy) to remove the inflammed appendix.
- This surgery was traditionally performed with an open cut. However, laparoscopic (keyhole)appendicectomy is now standard of care, as it allows for faster recovery with less pain and smaller scars.
- If the appendix has ruptured with a walled-off abscess around it, initial drainage of the abscess, by placing a tube through the skin with the help of CT or ultrasound, may be recommended. Intravenous antibiotics will also be given. Once the infection is under control, appendicectomy is then performed several weeks later.
- Patients with free rupture of the appendix with pus in the abdominal cavity are not suitable for this mode of treatment. Instead, immediate surgery is required to remove the appendix and clean up the pus in the abdominal cavity. If you suspect you have appendicitis, go to the Accident and Emergency room (A&E), or make an appointment with our specialists at Surgical Associates.
Senior Consultant Hepatopancreatobiliary Surgeon
MBBS, MMed (Surgery), MSc, FAMS, FRCSEd
Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the
Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He
served as the
Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program
SingHealth Surgical Skills Centre.
He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.
He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.
Senior Consultant Colorectal Surgeon
MBBS, MMed (Surgery), FAMS, FRCSEd
Dr Tan Wah Siew was senior consultant surgeon at the Department of Colorectal Surgery, Singapore
Hospital (SGH) prior to her move to private practice. She was the first female
consultant colorectal surgeon in
the history of SGH, and was one of the earliest female surgeons in Singapore to be trained in
She graduated from the Faculty of Medicine, National University of Singapore in 2003 and completed her Advanced Surgical Training in General and Colorectal Surgery at SGH in 2011. In 2013, she completed a one year Ministry of Health sponsored Healthcare Manpower Development Plan Fellowship (HMDP) at St. James University Hospital in Leeds, United Kingdom. While there, she trained in minimally invasive and robotic colorectal surgery for colorectal cancer, surgery for inflammatory bowel disease as well as treatment of locally advanced rectal cancers and recurrent pelvic cancers requiring removal of multiple organs and/or pelvic exenterations.