The symptoms of acute appendicitis initially begin with dull, diffuse and not exactly localizable abdominal pain around the navel (periumbillikal). Within a few hours, the pain shifts to the right lower abdomen and from then on is a constant and quite precisely localizable permanent pain (“point pain”). This pain is often aggravated by coughing and walking.
Such a shift in symptoms shows the change between visceral (“visceral pain“) pain and somatic (“body pain”) pain. The pain is often accompanied by vegetative symptoms such as nausea, vomiting, diarrhoea or constipation. At the same time, a slight fever of up to 38.5°C occurs.
In the case of a perforation (inflammatory breakthrough through the intestinal wall into the abdominal cavity), symptoms of short-term relief and pain relief may occur under certain circumstances. However, this brief improvement is worsened again by the subsequent peritonitis. The pain spreads further into the abdominal cavity and is often accompanied by a deterioration in the general condition.
If no rapid therapeutic intervention is taken, the patient may suffer a septic-toxic shock (blood poisoning with bacterial toxins). When diagnosing appendicitis, it should be remembered that only 50% of those affected have typical symptoms. Especially small children and elderly people have disease courses that are accompanied by less typical symptoms.
Diarrhoea is not a clear sign of appendicitis. Many other diseases of the digestive tract, especially of the intestine, can lead to more or less severe diarrhoea. They are therefore not a conclusive symptom of appendicitis, but often occur as an accompanying symptom.
In combination with the typical pain symptomatology or general lower abdominal pain, diarrhoea occurs relatively frequently in locally advanced appendicitis. It is important for the attending physicians to consider and check this possibility, as colitis is often assumed to be inflammation of the large intestine (enteritis). This assumption delays the determination of the actual disease situation and thus worsens the prognosis for the patient.
Flatulence can occur as a concomitant symptom of appendicitis, but can also be misleading. The inflammatory process in the presence of appendicitis can lead to digestive disorders, which manifest themselves in symptoms such as diarrhoea or constipation. Flatulence can also result from these circumstances, but in no way gives a clear indication of an existing appendicitis.
Misleading can be the pain which can be caused by severe flatulence. The fact that the air in the intestine migrates can also cause the pain caused by the flatulence to migrate. The feeling that the characteristic pain symptomatology may be present is intensified.
However, in most cases flatulence can be cured by massages or hot-water bottles – but not pain caused by appendicitis. Since appendicitis is caused by bacteria, the body reacts as with any more severe bacterial infection with a rise in temperature – the patient develops a fever. Due to the increased temperature, the immune system‘s defence cells can work better, but this only applies to 38 to 40 °C. The special feature of fever during appendicitis is the difference in temperature between the armpit and the rectum. If the difference is more than 0.5 °C and if abdominal pain or even characteristic symptoms also occur, this can be a good indication of an existing appendicitis (inflammation of the appendix).