Appendicitis is a common acute abdominal condition, medically referred to as appendicitis. It is an inflammation of the vermiform appendix, also known as the appendix vermiformis. Appendicitis often occurs suddenly and causes typical abdominal pain that initially begins in the upper abdomen or around the navel.
As the condition progresses, the pain shifts to the lower right abdomen, which is a classic symptom of appendicitis. Appendicitis can be caused by an obstruction of the appendix, such as fecal stones or a bacterial infection. If appendicitis is not diagnosed in time, there is a risk of a ruptured appendix, which can lead to serious complications such as peritonitis.
Therefore, any suspicion of appendicitis should always be evaluated by a doctor.
Definition: What is appendicitis?
The cecum is located at the beginning of the ascending colon, where it joins the small intestine. It ends “blindly” and protrudes into the abdominal cavity in the form of a pouch. At the lower end of the cecum is a worm-like appendage, approximately 10 centimeters long, known as the vermiform appendix (Appendix vermiformis).
Illustration of the cecum and appendix © freshidea | AdobeStock
In common parlance, the inflammation of this appendix is referred to as appendicitis.
The term “appendicitis” is therefore technically incorrect, since this condition does not affect the cecum itself, but rather its vermiform appendix. Medical professionals therefore generally refer to it as appendicitis rather than “appendicitis.” The video shows how appendicitis develops:
Types of Appendicitis
Appendicitis is generally classified into
- acute and
- chronic or recurrent appendicitis
and, second, between
- simple appendicitis (appendicitis simplex)
- and destructive appendicitis (appendicitis destructiva).
In simple appendicitis, no tissue is destroyed. In destructive appendicitis, the tissue gradually breaks down.
Destructive appendicitis therefore carries the risk of a ruptured appendix. In this case, the inflamed appendix bursts, allowing bacteria and intestinal contents to enter the abdominal cavity. A ruptured appendix therefore requires immediate surgery!
Prevalence of Appendicitis
Appendicitis is very common. It is the most common abdominal condition. In Western countries, approximately 100 out of every 100,000 people develop appendicitis each year.
Overall, the lifetime risk of developing appendicitis is about 7 percent. It most commonly affects
- younger people between the ages of 10 and 30, particularly older children and adolescents
- pregnant women.
In contrast, young children and the elderly rarely develop appendicitis. However, appendicitis can occur at any age.
© Adam Gregor / Fotolia
Causes of Appendicitis
Appendicitis can have various causes. In most cases, it is caused by a blockage of the appendix resulting from
- fecal stones,
- a kink in the appendix, or
- foreign objects such as swallowed fruit pits or tumors
. The blockage causes secretions containing bacteria to accumulate in the appendix, which irritate the mucous membrane and thus lead to appendicitis.
Other possible causes of appendicitis include inflammatory bowel diseases such as Crohn’s disease or bacterial infections.
Symptoms of appendicitis
The symptoms of appendicitis usually develop rapidly within 12 to 24 hours. However, a slower onset of symptoms is also possible.
Initially, pain typically occurs around the navel and in the upper abdomen. As the condition progresses, this pain shifts to the lower right abdomen. The abdominal wall in that area usually becomes so tender that any pressure—and even normal walking—worsens the abdominal pain.
Other typical symptoms of appendicitis include
- loss of appetite,
- nausea and vomiting,
- diarrhea,
- constipation,
- elevated temperature, possibly leading to a fever,
- rapid pulse, and
- night sweats.
However, these classic symptoms do not always occur. In particular,
- toddlers,
- pregnant women, and
- older adults
often present with an atypical clinical picture, with different or less pronounced symptoms.
For example, pregnant women often complain of pain in the upper or middle right abdomen, as the appendix is displaced due to the pregnancy.
Older adults with appendicitis often experience less severe pain and only a slight fever.
Young children with appendicitis often experience pain throughout the entire abdomen.
In pregnant women, pain from appendicitis tends to occur in the upper and middle abdomen © Yakobchuk Olena | AdobeStock
Diagnosis of Appendicitis
To diagnose appendicitis, the first step is a medical history interview. During this, the doctor asks the patient about the nature and duration of their symptoms.
The doctor then performs a physical examination, palpating the patient’s abdomen and abdominal wall. During this process, the doctor pays particular attention to tenderness in the lower right abdomen.
Characteristic tender points that indicate appendicitis are
- McBurney’s point, located midway between the navel and the right iliac crest,
- Lanz’s point in the right and middle thirds between the two iliac crests,
- release pain
- and, in children, psoas pain (in which children are asked to bend their leg at the hip against resistance).
In addition, a fever and a blood test showing an elevated white blood cell count due to the infection can support the suspicion of appendicitis.
An ultrasound examination can visualize the inflamed appendix.
In women, a gynecological examination should also be performed to rule out conditions affecting the internal reproductive organs, such as
- ovarian inflammation or
- an ectopic pregnancy,
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.
Treatment for appendicitis usually involves the surgical removal of the inflamed appendix (appendectomy). Ideally, this should be done immediately after the onset of symptoms.
The surgery can be performed laparoscopically (minimally invasive) or as open surgery via a longer skin incision. Minimally invasive surgery (MIC) is the standard approach.
Open Surgery
In open surgery, access is gained through an incision about five centimeters long in the lower right abdomen, known as a laparotomy (a soft-tissue incision).
The surgeon removes the inflamed appendix and then sutures the resulting opening in the intestine closed. This procedure requires general anesthesia and takes about 20 minutes.
Nowadays, this open surgery is mostly being replaced by minimally invasive surgery using a laparoscope. However, since the laparoscopic surgical method is only appropriate in the early stages of appendicitis, advanced cases of appendicitis—where the risk of infection is too high—continue to be treated with open surgery. The advantage is exploration, i.e., inspection of the entire abdominal cavity.
Laparoscopic Surgery
A minimally invasive, laparoscopic appendectomy is also known as laparoscopy or keyhole surgery.
Access is gained through three small incisions in the abdominal wall. Through these incisions, the surgeon inserts the necessary surgical instruments as well as a special mini-camera with a light source into the abdominal cavity. The camera’s image is displayed live on a monitor, giving the surgeon a direct view of the surgical site (3D).
This allows the surgeon to remove the inflamed appendix using the special instruments inserted into the abdominal cavity and then extract it through the abdominal wall. Finally, the resulting opening in the intestine is sutured closed.
Prognosis for Appendicitis
If the inflamed appendix is surgically removed early on, the prognosis is good. Patients usually make a full recovery from appendicitis after surgery.
If treatment is delayed, appendicitis can lead to serious complications and may even be fatal. However, this is very rare.
FAQ
How can you recognize appendicitis?
People often recognize appendicitis by severe abdominal pain that moves from the area around the navel to the lower right abdomen. Typical symptoms of appendicitis include nausea, vomiting, and a tense abdominal wall. Severe pain upon palpation can also be a sign of appendicitis.
What is the difference between the appendix and the vermiform appendix?
The cecum is the first section of the large intestine, from which the appendix hangs. Appendicitis does not affect the entire cecum, but rather involves inflammation of the appendix. Medical professionals therefore refer to this condition as appendicitis.
Is surgery always necessary for appendicitis?
Surgery is often necessary for acute appendicitis. Typically, a minimally invasive procedure with small incisions is performed; open surgery is less common. In uncomplicated cases of appendicitis, conservative treatment with antibiotics may be considered in some instances.
What happens if the appendix ruptures?
If appendicitis is not treated in time, the inflamed appendix may perforate. Such a perforation causes pus and bacteria to enter the abdominal cavity. This can lead to life-threatening peritonitis.
Is appendicitis common?
Appendicitis is common in younger people but can also affect older adults. In rare cases, chronic appendicitis may be present, or the symptoms may be mistaken for other conditions such as Crohn’s disease or a tumor. If appendicitis is suspected, a doctor should be consulted promptly.
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