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.
Drainage of abscess, with appendicectomy at a
- 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.