What is appendicitis?
Appendicitis is inflammation of the appendix. The appendix is a worm-like extension of the large bowel, found in the lower right area of the abdomen. Whilst the appendix has a function in different animals, it has no known purpose in humans.
What causes appendicitis?
It is thought that the main cause is that the appendix becomes blocked, causing inflammation. This may resolve spontaneously, but more often progresses. If left long enough, appendicitis can cause serious illness and even be life-threatening.
What symptoms can appendicitis cause?
Classically, appendicitis starts as pain around the belly-button area. After a few hours this moves to the right lower abdomen or occasionally flank area. The pain is usually worse when moving or coughing, and can be severe.
Loss of appetite almost always happens, which may be accompanied by nausea.
A high temperature may occur later on in appendicitis but not usually at an early stage.
What tests can be done?
The diagnosis of appendicitis is mostly made by the doctor's findings when examining you and the story given by yourself.
If any doubt exists, more information may be gained with blood tests. Scans generally do not help in diagnosing appendicitis, but can help find other causes of abdominal pain.
Occasionally the specialist may organise a laparoscopy - whilst under anaesthesia, narrow telescopes are used to look into the abdomen through small cuts. If the appendix is inflamed, it can be removed at the same time. A laparoscopy may be particularly useful in females, where ovarian problems can mimic appendicitis; the specialist would be able to have a look at the ovaries and see if any problems exist whilst checking the appendix.
How is appendicitis treated?
Surgery will be needed to remove the inflamed appendix. This can be performed laparoscopically (as described above) or as an 'open' operation. Both are performed under general anaesthetic. Open surgery involves a small cut being made in the lower right hand area of the abdomen. The appendix can then be removed and the wound stitched closed
About a fifth of removed appendixes will be normal. In this case the surgeon will have a careful look for any other causes of the abdominal pain. If a cause is found then this may be treatable at the same time, or further treatment may be planned for a later date.
What are the risks of appendix removal?
Hernia - if the deep tummy muscles do not heal well after the surgery, the underlying bowel could push through the muscle, being seen or felt as a lump. Hernias may need an operation to treat them.
Infection - this may require antibiotics, or rarely further surgery.
Injury to other structures - injury to bowel, nerves or blood vessels is rare but can occur, which may need further surgery.
Bowel leakage - after the appendix stump is closed there is a small risk that a leak may occur, allowing bowel contents to escape into the abdomen. This often needs further surgery.
Adhesions - surgery in the abdomen will lead to scar tissue forming. This can stick to nearby bowel, which may cause problems such as obstruction. This can require further surgery.
Difficulty passing urine - if this happens you may need a tube (catheter) for a day or two to help you pass water.
Blood clots in the legs - clots in the calf (deep vein thrombosis / DVT) can usually be treated with medication, but a DVT can (rarely) move to the lungs. This can cause breathing difficulty, or even be life threatening.
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Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.
The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer