Appendicitis - colloquially known as appendicitis - is an inflammation of thevermiform appendix (appendix vermiformis), which is attached to the appendix. Appendicitis is the most common disease in the abdomen and affects younger people between the ages of 10 and 30. If appendicitis is not treated quickly, it can have serious consequences. Here you will find further information and selected appendicitis specialists and centers.
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Article overview
Definition: What is appendicitis?
The appendix is located at the beginning of the ascending colon at the junction of the small intestine. It ends "blind" and protrudes into the abdominal cavity in the shape of a sac. At the lower end of the appendix there is a worm-like appendage about 10 centimetres long, the so-calledvermiform appendix.
Illustration of the appendix and vermiform appendix © freshidea | AdobeStock
The inflammation of this appendix is commonly referred to as appendicitis .
The term appendicitis is therefore incorrect, as this disease does not affect the appendix itself, but its appendix. Doctors therefore generally speak of appendicitis and not appendicitis.
The video shows how appendicitis develops:
Types of appendicitis
In the case of appendicitis, a distinction is made between
- acute and
- chronic or recurrent appendicitis on the one hand
and on the other hand between
- simple appendicitis(appendicitis simplex)
- and destructiveappendicitis (appendicitis destructiva).
In simple appendicitis, no tissue is destroyed. In destructive appendicitis, the tissue gradually disintegrates.
Destructive appendicitis therefore carries the risk of a rupture of the appendix. The inflamed appendix bursts open and bacteria and intestinal contents can enter the abdominal cavity. Immediate surgery is therefore necessary if the appendix ruptures!
Frequency of appendicitis
Appendicitis is very common. It is the most common disease of the abdominal cavity. In Western countries, around 100 out of every 100,000 inhabitants suffer from appendicitis every year.
Overall, the risk of developing appendicitis in the course of a lifetime is around 7 percent. Those most frequently affected are
- younger people between the ages of 10 and 30, especially older children and adolescents
- pregnant women.
Young children and elderly people, on the other hand, are less likely to develop appendicitis. In principle, however, appendicitis is possible at any age.
Adam Gregor / Fotolia
Causes of appendicitis
Appendicitis can have various causes. In most cases, a blockage of the appendix caused by
- fecal stones,
- a kink in the appendix or
- foreign bodies such as swallowed fruit stones or tumors
are responsible for appendicitis. The blockage causes secretions with bacteria to accumulate in the appendix, which irritate the mucous membrane and lead to appendicitis.
Other possible causes of appendicitis are inflammatory bowel diseases such as Crohn's disease or bacterial infections.
Symptoms of appendicitis
The symptoms of appendicitis usually develop rapidly within a period of 12 to 24 hours. However, a slower development of symptoms is also possible.
Initially, pain typically occurs in the navel and stomach area. This pain then shifts to the right lower abdomen. The abdominal wall there usually becomes so sensitive that any pressure and even normal walking aggravates the abdominal pain.
Other typical symptoms of appendicitis are
- Loss of appetite,
- nausea and vomiting,
- diarrhea,
- stool retention,
- increased temperature and even fever,
- accelerated pulse and
- night sweats.
However, these classic symptoms do not always occur. For example
- small children,
- pregnant women and
- older people
often show an atypical clinical picture with different or less pronounced symptoms.
Pregnant women, for example, often complain of pain in the right upper or middle abdomen, as the appendix is displaced due to pregnancy.
Older people with appendicitis often have less severe pain and only a slight increase in temperature.
Small children with appendicitis often suffer from pain throughout the abdomen.
In pregnant women, the pain of appendicitis tends to occur in the upper and middle abdomen © Yakobchuk Olena | AdobeStock
Diagnosis of appendicitis
The first step in diagnosing appendicitis is to take a medical history. The doctor asks the patient about the nature and duration of the symptoms.
The doctor then carries out a physical examination. He will palpate the patient's abdomen or abdominal wall. The doctor pays particular attention to pressure pain in the lower right abdomen.
Characteristic pressure and pain points that indicate appendicitis are
- the McBurney point in the middle between the navel and the right iliac crest,
- the Lanz point in the right and middle third between the two iliac spines,
- the release pain
- and psoas pain in children (children should bend their leg at the hip against resistance).
In addition, an increased body temperature and a blood test, which shows an increased number of white blood cells due to the infection, can support the suspicion of appendicitis.
An ultrasound examination can make the inflamed appendix visible.
In women, a gynecological examination should also be carried out to detect diseases of the internal reproductive organs, such as
- ovarian inflammation or
- an ectopic pregnancy,
can be ruled out.
Treatment of appendicitis
Appendicitis should be treated as quickly as possible. Otherwise complications such as a ruptured appendix or peritonitis could occur.
The treatment of appendicitis usually consists of the surgical removal of the inflamed appendix (appendectomy). Ideally, this should be done immediately after the onset of the disease.
The operation can be performed laparoscopically (minimally invasive) or openly via a longer incision. Minimally invasive surgery (MIS) is standard.
Open surgery
In open surgery, access is gained via an approximately five centimeter long incision in the lower right abdomen, a so-called laparotomy (soft tissue incision).
The surgeon cuts out the inflamed appendix of the appendix and then sutures the intestinal opening created at this point.
Such an operation requires general anesthesia and takes about 20 minutes.
Nowadays, this open operation is usually replaced by minimally invasive surgery using a laparoscope. However, as the laparoscopic surgical method only makes sense in the early stages of appendicitis, advanced appendicitis, where the risk of infection is too high, continues to be operated on directly in the open. The advantage is the exploration, i.e. inspection of the entire abdominal cavity.
Laparoscopic surgery
Minimally invasive, laparoscopic appendectomy is also known as laparoscopy or keyhole surgery.
Access is gained via three small incisions in the abdominal wall. The surgeon inserts the required surgical instruments and a special mini camera with a light source into the abdominal cavity through these incisions. The image from the camera is displayed live on a monitor so that the surgeon has a direct view of the operating area (3D).
This allows him to separate the inflamed appendix with the special instruments inserted into the abdominal cavity and then pull it out through the abdominal wall. Finally, the resulting intestinal opening is sutured.
Prognosis for appendicitis appendicitis
If the inflamed appendix is surgically removed at an early stage, the prognosis is good. Patients usually recover completely from appendicitis after the operation.
If treated late, appendicitis can lead to serious complications and can potentially be fatal. However, this is very rare.