What is appendicitis? – Appendix is a tube-like organ, about the size of a finger, attached to the caecum (beginning of the large intestine), around the junction of the small and large intestine. It is located around the right lower part of the abdomen. The inflammation (infection, swelling, associated with pain) of this structure is known as appendicitis. This occurs when the appendix is blocked and infected. It is a serious health condition that requires prompt medical attention. 

What causes appendicitis?

The appendix is a tube-like structure which opens directly into the large intestine, in which feces moves down to the rectum. This feces contains numerous bacteria which can get trapped inside the appendix and overgrow to cause infection. The activities of these bacteria may lead to infection and swelling of the appendix (inflammation).

This swelling may, in turn, block the opening of the appendix, preventing the bacteria from being washed away. The swelling therefore becomes worse as time goes on and may lead to rupture of the appendix, if not treated on time.

Sometimes, pieces of feces moving along the large intestine may block the opening of the appendix into the large intestine; thereby preventing its secretions from being emptied into the large intestine. Bacteria from this fecal matter may then cause infection in the appendix, resulting in its inflammation. Here, infection is secondary to blockage of the appendix.

At times, there is swelling of the lymphatic system, which is part of the immune system of the body, which includes the appendix. This swelling in the appendix can block its secretion, thereby resulting in overgrowth of the bacteria trapped inside it and subsequently, inflammation. Occasionally, inflammation of the appendix may be part of the general inflammation of the large intestine to which it is attached.

Which category of people have appendicitis?

Appendicitis affects all categories of people from infants to elderly. However, it is more common in persons between the ages of 10 and 30 years.

What are the symptoms of appendicitis?

Appendicitis presents with typical symptoms of abdominal pain, nausea, vomiting and loss of appetite. These typical symptoms may not be present in up to 50% of affected persons, especially pregnant women, children and the elderly. Other symptoms include fever, abdominal swelling (especially in cases of rupture / perforation), frequent urination, constipation or diarrhea. 

The abdominal pain of appendicitis usually starts around the umbilicus (belly button). It may remain constant here for some hours or get resolved and occurs again. This may be accompanied by nausea and vomiting. The pain gradually shifts to the right lower part of the abdomen, where the appendix is located.

What is the treatment for appendicitis?

Appendicitis is an emergency. Affected patients are admitted. The definitive treatment is surgery,  which is usually performed within 24 hours of admission. The appendix is removed during the procedure (appendectomy) and patient may be able to go home the same day, if this is done through laparoscopy.

Those who have open surgery may be on admission for a few days after the procedure. Drug treatment (antibiotics and pain relief) is necessary to treat the infection and post-operative pain. Sometimes, drug treatment alone (antibiotics) may be given, with subsequent resolution of the symptoms. However, the possibility of recurrence is high. Therefore, the use of only antibiotics for the treatment of appendicitis is not encouraged.  

What complications can occur from appendicitis?

If left untreated or treatment is delayed, it may lead to complications which include the following:

1. Peritonitis - This refers to infection of the peritoneal cavity (the space in the abdomen, covered by a thin membrane known as peritoneum, housing the intestine). This results in severe generalized abdominal pain, which is very discomforting to the affected person.
2. Sepsis - This refers to the spread of infection from the appendix to the rest of the body, usually through the blood stream. 
3. Gangrene - Prolonged distension of the appendix leads to reduction of blood supply to the tissue. This, in turn, leads to the death of the cells of the appendix, and ultimately the entire tissue (gangrene). The wall of the dead portion may then tear / perforate, discharging part of its content into the abdominal cavity, worsening the symptoms (peritonitis). 
4. Abscess formation - The infection of the appendix may result in formation of pus around the appendix. The body tries to contain the pus within a limited area in order to prevent it from spreading wide. This may result in a mass / swelling around the appendix.

What effect does removal of appendix have?

Removal of appendix following appendicitis does not have any known adverse effect on the patient, as appendix has no known specific function it performs in the body. 

Can appendicitis be prevented?

There is no known preventive measure for appendicitis.