Appendicitis is an inflammation of the vermiform appendix (appendix) of the caecum. Typical symptoms are pain in the right lower abdomen accompanied by nausea or fever.
Appendicitis usually becomes acute within a few hours. Due to possible complications such as circulatory disorders, sepsis (blood poisoning) or perforation (bursting) of the inflamed appendix, appendicitis is often treated surgically. In certain cases, such as specific chronic or subacute forms of appendicitis, antibiotic treatment may also be considered.
Overview
The appendix (caecum) is located in the right lower abdomen. At the fundus of the caecum, there is an appendage measuring 2 to 20 cm in length and 0.5 to 1 cm in thickness known as the vermiform appendix (appendix). This can become inflamed due to a blockage or obstruction. This may be caused by faecal stones, worms, intestinal contents or foreign bodies (e.g. fruit stones/seeds). In rare cases, an infection caused by bacteria or viruses can also lead to appendicitis. This type of inflammation usually presents as severe abdominal pain in the right lower abdomen, accompanied by fever and nausea.
If the appendix becomes inflamed, this can lead to serious and sometimes life-threatening complications. For this reason, if there is reasonable suspicion, an appendectomy (surgical removal of the appendix) would be considered the appropriate treatment and should be carried out as soon as possible.
Causes and risk factors
Appendicitis is one of the most common types of intestinal inflammation requiring treatment, affecting about 1 in 1 000 people per year. In most cases, there is no specific cause that can be identified as the trigger for appendicitis. It is thought that it may be due to food residues or stool particles that have been deposited in the appendix. It is thought that it may be due to food residues or stool particles that have been deposited in the appendix. Occasionally, fruit stones such as cherry stones are blamed.
Various factors can increase the risk of appendicitis, including:
Age
Whether in children or adults, appendicitis can occur at any age; however, it most commonly affects people aged between 10 and 30.
Gender
Men and women have different levels of risk for appendicitis. Men are at higher risk, as about 9 percent of them will experience acute appendicitis during their lifetime, while for women the risk is about 7 percent.
Nutrition
A diet high in roughage and fibre, which stimulates intestinal activity and promotes digestion, reduces the risk of appendicitis, while a diet low in these nutrients may increase the risk.
It is important to note that these factors may increase the risk but do not necessarily cause appendicitis.
Uncomplicated appendicitis
Uncomplicated appendicitis, the most common form of appendicitis, describes the inflammation of the appendix. Typical symptoms are sudden pain in the upper abdomen, which increases over some hours and travels to the right lower abdomen, accompanied by nausea or fever. Although it is now considered possible that this form can clear up on its own, in most cases the appendix is removed by surgery to prevent complications arising.
Bursting of the appendix (perforation)
If the inflammation spreads to neighbouring tissue, the appendix may perforate. Through the hole in the intestinal wall created by the perforation, fluid from the wound, bacteria and pus can enter the abdominal cavity, which can lead to life-threatening peritonitis and usually results in emergency surgery. Through the hole in the intestinal wall created by the perforation, fluid from the wound, bacteria and pus can enter the abdominal cavity. This can lead to life-threatening peritonitis and usually results in emergency surgery. Symptoms such as a hard abdominal wall, a curled-up relieving posture, paleness, increased heart rate and light-headedness, indicate that the inflamed appendix has burst.
Chronic appendicitis
Occasionally, the appendix can become chronically inflamed and cause long-lasting or recurring symptoms. Chronic or subacute appendicitis can also be treated with antibiotics. If the chronic inflammatory phases occur repeatedly, surgical removal of the appendix is recommended in most cases. If the chronic inflammatory phases occur repeatedly, surgical removal of the appendix is often also recommended.
Appendicitis symptoms
Appendicitis typically starts with pain in the upper abdominal area or near the belly button. This pain quickly moves to the right lower abdomen and becomes severe.
Additional symptoms of appendicitis may develop later on. These include:
- Nausea and vomiting
- Constipation
- Diarrhoea
- fever
- Loss of appetite
If a ruptured appendix is suspected, it is important to seek medical help immediately.
It is important to note that the typical symptoms do not occur in all cases. In young children in particular, the symptoms of this illness are not always clear-cut. Since an inflamed appendix can quickly become life-threatening, children with symptoms should always be examined by a doctor.
Physical examination
During the physical examination, the doctor will palpate the abdomen and check for painful reactions when pressing on certain areas.
Blood test
A blood sample is taken to measure the levels of inflammatory markers in the blood.
Ultrasound examination (Sonography)
An ultrasound examination is carried out to determine whether the appendix has changed or whether pus has formed.
Computed tomography (CT) or magnetic resonance imaging (MRI)
In addition, a CT or MRI scan may be carried out to check for swelling of the appendix and a build-up of pus or fluid.
Treating appendicitis
Treatment of acute appendicitis is usually carried out within 24 hours of diagnosis by either laparoscopic or open appendectomy.
To remove the inflamed appendix, laparoscopic surgery is generally preferred. In this minimally invasive procedure, surgical instruments and a camera are inserted into the abdomen through thin tubes. With the surgeon viewing the procedure via a camera, the appendix is then exposed and removed.
Open surgery is occasionally required, especially if the inflammation has already spread. This requires an approximately 6 cm long incision in the right lower abdomen.
In cases of uncomplicated appendicitis, surgery can sometimes be dispensed with and antibiotics constitute the sole treatment. However, there is an increased risk of re-inflammation of the appendix.
Prevention
In general, no specific preventive measures are known to prevent appendicitis. However, a diet rich in fibre can stimulate intestinal activity and promote digestion, thus reducing the risk.
What should you do if you have appendicitis?
People with appendicitis cannot treat it themselves. If you suspect have appendicitis, you should consult a doctor as soon as possible and refrain from applying heat in the hope of relieving pain; heat can actually make the inflammation worse. In addition, painkillers should not be taken if you are experiencing typical appendicitis symptoms. This will allow the doctor to clearly identify these symptoms during a physical examination, make a diagnosis and, if necessary, arrange for an appendectomy to be carried out by a surgeon.
How quickly do patients need to act when they have this illness?
Appendicitis usually develops within a few hours. It should be assessed by a doctor as soon as possible and, if necessary, treated surgically. If treatment is delayed for too long, there is a risk of an intestinal rupture (perforation), which can lead to life-threatening peritonitis.
When should you see a doctor or go to the emergency room if you suspect you have appendicitis?
If you have severe or worsening abdominal pain in the right lower abdomen, you should seek medical help immediately. If you suspect you have appendicitis, you should look out for typical symptoms such as fever, nausea or loss of appetite. It is important to seek immediate medical attention if the pain or other symptoms suddenly worsen or if you experience circulatory problems.
Can appendicitis go away on its own?
In some cases, a mild, uncomplicated bout of appendicitis can resolve on its own. However, as it is not possible to predict with certainty how the illness will develop, symptoms of appendicitis should always be examined by a doctor. This allows complications to be detected at an early stage.
When is surgery necessary and what does the procedure involve?
An appendectomy is usually recommended in cases of acute appendicitis or if there is a risk of complications. In most cases, an appendectomy is performed using a minimally invasive procedure whereby small incisions are made in the abdomen. The inflamed appendix is removed to prevent it from rupturing.
How dangerous is a ruptured appendix?
A ruptured appendix is a life-threatening complication in which the inflamed tissue tears, allowing bacteria and faecal matter to enter the abdominal cavity. This causes life-threatening peritonitis, which is considered a medical emergency and must be treated immediately in hospital.
How long does it take to recover from an appendectomy?
If the appendectomy goes without any hiccups, many patients can leave hospital after just a few days. Full recovery usually takes two to four weeks. The exact duration depends on the procedure, the course of the illness and the patient’s general state of health.
