Colleton Medical Center - August 31, 2017
by Karl Stiegler, MD

The appendix is a small, tube-like vestigial organ that hangs from the large intestine, with an immune-related function early in life, but adults can live a normal life without it. Appendicitis is inflammation of the appendix, usually caused by a foreign body trapped inside.

While blocked by the foreign body, the lining of the appendix continues to produce mucus, but that mucus has no egress point. Bacteria normally found in the intestines can then build up and make toxins in the lining of the appendix, building pressure and causing severe pain in the abdomen. The wall of the appendix can then break open, spilling the contents into the abdominal cavity, causing serious redness and swelling. This is called peritonitis, and it can be fatal.

Appendicitis is more common in men and teenagers, and family history seems to play a role in increased risk of developing the condition. Symptoms usually emerge quickly with pain increasing over a period of 6-12 hours, and may be different in infants, children, pregnant women, and the elderly.

Patients may have some or all of the following pain symptoms:

  • Discomfort around the belly button, moving to the right side of the abdomen over several hours
  • May be in a different location if the appendix is not in the usual place
  • Increases as redness and swelling in the appendix builds
  • Worsens with sneezing, coughing, and deep breathing
  • May increase with movement

Patients may also experience:

  • Loss of appetite
  • Nausea and vomiting
  • Abdominal swelling
  • Abdomen feels hard and is sensitive to touch
  • Constipation
  • Mild diarrhea
  • Slight fever

If the appendix ruptures, symptoms include:

  • Pain becoming stronger and spreading across the abdomen
  • Increasing fever

If you have severe pain in the abdomen, get medical help right away, as appendicitis can be hard to diagnose. Symptoms vary and can be similar to symptoms of other diseases, so your provider will want to do a full exam and get detailed medical history. The exam may include:

  • A careful examination of the abdomen
  • A rectal exam
  • Blood and urine tests
  • Ultrasound
  • Computed tomography (CT) scan
  • Laparoscopy

Appendicitis is usually treated treated by surgically removing the appendix as soon as possible (appendectomy). Because sometimes the diagnosis is not certain, the patient’s condition will be carefully monitored for 6-12 hours before operating, and patients are also given antibiotics to fight infection. Sometimes appendicitis does not need to be treated with surgery and the treatment is just a strong course of antibiotics.

Problems and complications from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like bleeding, infection, other organ damage, and reactions to anesthesia. Complications are more common in the elderly, but other risk factors are smoking, a ruptured appendix, obesity, diabetes, chronic lung or heart disease, and pregnancy.

The Appendectomy Procedure

The majority of appendectomies are performed laparoscopically with small incisions and a camera, resulting in less pain and quicker recovery time. The procedure normally takes between 30 minutes to 1 hour, although in infrequent cases, it can take longer and require conversion to an open procedure. As a result of these advanced techniques, some patients can go home the same day, and others go home the next day.

If the appendix has ruptured, a warm water solution mixed with antibiotics will be used to wash out the inside of the abdomen. A catheter will then be placed to drain any fluid that builds up. Sometimes, with a rupture, the surgeon will only close the muscle layers and leave the skin open. The open skin wound will then be packed with a moist gauze dressing.

After the Procedure

Right after the procedure, the patient will be in a recovery room where blood pressure, pulse, and breathing will be monitored. During this time, the removed tissue will be examined by a pathologist. Recovery may also include pain medications, antibiotics to prevent infection, medication to prevent blood clots, and resuming movement within 24 hours of surgery. If the appendix ruptured, drainage tubes will be removed after a few days.

Recovery from the Appendectomy

Recovery time for the procedure is generally 10-14 days, and in some cases sooner. Patients will be advised to slowly increase activities as approved by their provider, and to avoid exercise or heavy lifting immediately post-surgery. Following the provider’s instruction is of paramount importance to healing quickly and effectively.

There are no guidelines to prevent appendicitis. It starts quickly and the cause is usually unknown. Get medical care right away for severe abdominal pain, as it will decrease the risk of rupture.

If you have questions about appendicitis, appendectomy, other general surgeries, contact Karl Stiegler, MD, of Coastal Carolina Surgical Specialists, at 843-549-1421.