Appendicitis, or appendicitis, is an inflammation of the vermiform appendix, a small appendage on the appendix. Although the name appendicitis is commonly used, it is not actually accurate because the inflammation is limited only to the appendix, which is attached to the beginning of the appendix. You can find out what causes inflammation of this appendix, how to recognize the symptoms of appendicitis, and what to do at the first signs here.
Causes of appendicitis
The appendix hangs from the appendix like a worm and is about one centimeter in diameter. Because of the narrowness around the orifice, it can easily become mechanically obstructed by foreign bodies, such as:
- Fecal stones (hardened chunks of stool).
- Cherry pits as well as other ostomies or foreign bodies.
- Worms
- Old scars
- Kinks in the case of adhesions
But also in the case of inflammation of the rest of the intestine, tonsillitis, flu, measles or scarlet fever, bacteria can enter the appendix through the blood. Its orifice then closes due to the swelling of the tissue. This causes secretions to accumulate, and the associated buildup of bacteria from the colon leads to a violent reaction, since the appendix is not used for digestion like the rest of the intestine, but is an organ of defense against infection.
Appendicitis: recognizing symptoms
Appendicitis often causes typical symptoms, but because these do not always occur, the inflammation is often not easy to recognize. Symptoms develop within 12 to 24 hours. Classically, the following course is seen:
- Initially, there is pain in the area of the navel or above, which is usually the first sign.
- This abdominal pain shifts to the lower right abdomen within a few hours, and the abdominal wall is tense.
- Pain when walking causes sufferers often pull the right leg a little.
- Bouncing on the right leg or lifting the right leg against resistance causes pain – this can often serve as the first test.
- Nausea also occurs, more often accompanied by vomiting and loss of appetite.
- At the so-called Mac-Burney point (between the navel and the iliac crest on the right), the signs of local peritonitis are present with defensive tension, local pressure and tapping pain. Even a light touch is very painful.
- Fever is also common in appendicitis.
- Sometimes the intestinal activity is restricted.
What to do if appendicitis is suspected?
If you suspect appendicitis, you should immediately see a doctor or go directly to the hospital. This is because in many cases, surgery is needed quickly. About it, you should not eat anything until further clarification, as this could aggravate the symptoms.
Diagnosis of appendicitis
The diagnosis of acute appendicitis is based on the medical history and physical examination. While the “classic” course described above can often provide clear evidence of appendicitis, deviations from this course may occur, especially in children, pregnant women, and older affected individuals. Even for the experienced physician, it is sometimes very difficult to recognize appendicitis with certainty. The following signs can often be detected during examination by the physician:
- The bowel sounds audible with a stethoscope are quieter than normal in appendicitis.
- In addition, there is fever with a temperature difference of more than 0.8 °C between the axilla and the anus.
- On palpation of the abdomen, as well as often on rectal examination, tenderness is detectable. The pressure pain is also often apparent when pressure is applied to a specific point in the left lower abdomen.
- The blood count also often shows signs of inflammation, for example, in terms of white blood cells or C-reactive protein (CRP).
- An ultrasound examination often reveals the inflamed appendix, and in individual cases a computed tomography (CT) scan may also be necessary.
- In children, diarrhea, high fever, loss of appetite and an early deterioration of the general condition may be seen.
- In elderly patients, the symptomatology may be attenuated but associated with a more rapid course.
- During pregnancy, the location of the appendix is altered, so the pain may be expressed atypically.
With these tests, the doctor can usually determine whether it is really appendicitis or, for example, a (more harmless) appendicitis.
Exclusion of other diseases
Other conditions with symptoms similar to appendicitis include gastroenteritis with diarrhea, inflammation of the gallbladder with stone disease (biliary colic), Crohn’s disease, and renal colic. In women, similar symptoms to appendicitis can be caused by inflammation of the fallopian tubes, tubal or abdominal pregnancy, pedunculated ovarian cyst, and pain at the time of ovulation. Therefore, in women, gynecological disease should be ruled out by appropriate examinations. In children, inflammatory swelling of the abdominal lymph nodes or diaphragmatic pneumonia may mimic appendicitis.
Appendicitis as a complication
The most important complication of appendicitis is the breakthrough of the purulent secretion from the appendix into the free abdominal cavity; this is called appendiceal perforation. At the moment of the breakthrough, the affected person may feel relief due to the clearing of the secretion stasis, but the pain quickly increases again. The spread of bacteria in the abdominal cavity can lead to peritonitis and acutely threaten the life of the affected person. It is essential to prevent this complication by timely treatment (usually surgery). After a perforation, encapsulation and demarcation by adhesion to the reticular apron and surrounding loops of small intestine with pus deposits is also possible (abscess). These abscesses can impair bowel function and sometimes cause bowel paralysis.
Treatment usually involves appendectomy
Any finding in which appendicitis cannot be ruled out after several hours of observation should be operated on. In cases of advanced inflammation, therapy with antibiotics and intravenous fluid administration is sometimes first initiated to combat the inflammation before surgery can take place. The surgery to remove the appendix (appendectomy) is performed by opening the abdominal wall with a small incision on the lower right abdomen. In severely overweight patients or those with an unclear diagnosis, the incision is made larger and along the middle of the lower abdomen because the surgeon then has a better view. This procedure is called open appendectomy. In the so-called laparoscopic appendectomy, optical instruments, i.e. cameras (endoscopy), are used, which means that only three small incisions are required. This method used to be performed only for planned operations, such as removal in the case of chronic appendicitis or after repeated mild inflammation during a symptom-free period. Nowadays, this technique is also used in emergency cases. In both cases, general anesthesia is required. To obtain certainty about the cause of the inflammation, the removed appendix is always examined histologically. Usually, the patient can be discharged from the hospital four to five days after the operation, provided that his bowel is functioning normally again and his general condition permits. After that, he or she should initially take it easy, and there is usually a sick leave for two to three weeks.
Therapy with antibiotics
Conservative treatment without surgery may be used for subacute appendicitis, i.e., mild appendicitis. For the affected person, this means bed rest, dietary restriction (abstaining from food), administration of antibiotics, laboratory control, and repeated examinations. Children are also often treated with antibiotics and painkillers. If this does not show the desired results, surgery is required. Although surgical removal of the appendix is considered the standard treatment for appendicitis, initial studies suggest that in many cases the administration of antibiotics may be sufficient. However, more detailed studies are still pending.
Complications after appendicitis
Uncomplicated appendicitis is cured after surgery.In some cases, however, adhesions can form in the area of the ablation site a few years after the appendectomy, which can then lead to mechanical bowel obstruction. An abscess, i.e. a collection of pus in the abdominal wall (abdominal wall abscess) or the abdominal cavity (Douglas abscess), can also occur a few days after the operation. If appendicitis has not been treated and has subsided on its own, scarring and adhesions may subsequently develop, which may promote re-inflammation of the appendix or even cause intestinal obstruction.
