What is Appendicitis?
Appendicitis occurs when the appendix gets inflamed and typically, the symptoms appear suddenly within a day. However, in instances where the appendix ruptures and forms an abscess, the signs might appear gradually and might not be as severe.
It’s vital to know that acute appendicitis is the main reason for belly surgeries in kids and is the most common surgical emergency for the abdomen across the globe. The significance of appendicitis in both kids and adults emphasizes the need for a correct diagnosis, quick action, and proper treatment. It is very important to understand how appendicitis presents and its unique nature to provide care on time and avoid complications associated with this common condition.
What Causes Appendicitis?
Appendicitis occurs when the appendix becomes inflamed due to a blockage. This blockage can be caused by hardened stool, tumors, parasites, or swollen lymphatic tissues. The specific cause of the blockage can vary depending on a person’s age, so age is an important factor to consider when diagnosing and treating appendicitis.
The appendix naturally contains certain types of bacteria, and when it becomes blocked, these bacteria can multiply excessively, leading to intense inflammation and the possible formation of an abscess. Research has shown that cases of severe appendicitis with a burst appendix have a higher presence of bacteria compared to cases of straightforward appendicitis. This suggests that the number of bacteria can impact the severity of appendicitis and the complexity of treatment.
In children, acute appendicitis is often caused by an overgrowth of lymphoid tissue in the appendix, which leads to inflammation and limited blood flow. This inflammation increases the risk of the appendix bursting and forming an abscess, resulting in an infection in the abdominal cavity. Sometimes this overgrowth of tissue is mistakenly identified as a cause of appendicitis.
In adults, acute appendicitis can be caused by infections, hardened stool, or tumors. Tumors such as adenocarcinoma of the appendix, mucocele, and carcinoid tumor can be linked to appendicitis in adults.
Risk Factors and Frequency for Appendicitis
Acute appendicitis, a common abdominal issue, sees anywhere from 100 to 223 new cases per 100,000 people every year. Specifically in the United States, there are about 300,000 hospital visits each year linked to appendicitis.
This condition can happen at any age but is mostly likely to occur in people between the ages of 5 and 45. The average age at which people are diagnosed is 28. It’s slightly more common in men than women, but it can occur in both genders. Over the course of their lives, about 8.6% of men and 6.7% of women will have acute appendicitis. However, the difference in occurrence between men and women is not very significant.
- Acute appendicitis is a frequent abdominal issue.
- New cases range from 100 to 223 per 100,000 people annually.
- About 300,000 annual hospital visits in the U.S. relate to appendicitis.
- It usually occurs in individuals aged 5 to 45.
- The typical age for diagnosis is 28.
- Acute appendicitis is slightly more common in males, but both genders can have it.
- About 8.6% of men and 6.7% of women will experience acute appendicitis in their lifetime.
Signs and Symptoms of Appendicitis
- Abdominal ache that relocates to the lower right side
- Pain worsens with movement and can awaken from sleep
- Loss of appetite
- Nausea and sometimes vomiting
- Diarrhea
- General feeling of being unwell
- Urgent or frequent urination
- Fever in some cases
- Tensed muscles and pain in right lower abdomen
- Dunphy sign, Rovsing sign, and Psoas sign
- Complications like infections in the portal vein, blockage of urine flow, bowel obstruction, and formation of abnormal connections
- Resistance to fever medication and significant weight loss in case of complications
- Symptoms worsen over 12 to 24 hours, but can extend beyond 48 hours in complicated cases
Testing for Appendicitis
When diagnosing acute appendicitis, doctors may conduct blood tests and use imaging techniques such as CT, ultrasound, or MRI. Blood tests, including a total leukocyte count and a serum C-reactive protein level test, can indicate the likelihood of appendicitis if the results are elevated. Imaging methods like CT scans have a high accuracy rate in detecting appendicitis, while ultrasound is useful for certain cases like children and pregnant women. MRI is effective but more expensive and requires expertise. Scoring systems like the Alvardo scoring system can also help in diagnosing appendicitis based on symptoms and test results.
Treatment Options for Appendicitis
Surgery is the primary treatment option for acute appendicitis, despite progress in using antibiotics. While antibiotics can be effective in the short term, 1 in 4 patients treated with antibiotics end up needing surgery within a year. Antibiotics as a sole treatment can lead to increased instances of peritonitis. Some trials suggest that antibiotics alone could be an option, but there are risks such as unnoticed dangerous conditions and doubts about long-term effectiveness. Specific antibiotics are used to treat appendicitis before surgery, depending on the types of bacteria present. In the emergency department, patients are given intravenous fluids and antibiotics. Laparoscopic appendectomy is the preferred method, but open surgery may be necessary in complicated cases. Alternative surgical techniques include NOTES and SILS, which have their own advantages and drawbacks.
What else can Appendicitis be?
When trying to diagnose acute appendicitis, there are a variety of other conditions that doctors also need to consider could be causing your symptoms, including:
- Crohn’s disease – inflammation of the digestive tract
- Mesenteric adenitis – swelling of the lymph nodes in the abdomen
- Cecal diverticulum – pouches in the wall of the cecum (part of the large intestine)
- Mittelschmerz – abdominal pain that occurs in the middle of the menstrual cycle
- Salpingitis – inflammation of the fallopian tubes
- Ruptured ovarian cyst
- Ectopic pregnancy – pregnancy that occurs outside the womb
- Tubo-ovarian abscess – a pocket of pus that forms on the ovaries and tubes
- Musculoskeletal disorders
- Endometriosis – a condition where the tissue that lines the womb is found elsewhere in the body
- Pelvic inflammatory disease – infection of the upper part of the female reproductive system
- Gastroenteritis – inflammation of the stomach and intestines, usually due to an infection
- Colitis – inflammation of the inner lining of the colon
- Renal colic – a type of abdominal pain that is usually caused by kidney stones
- Irritable bowel disease
- Testicular or ovarian torsion – twisting of the testes or ovaries
- Round ligament syndrome – pain in the abdomen or hip area during pregnancy
- Epididymitis – inflammation of the coil of small tubes behind the testes
In order to correctly identify the cause of the abdominal pain, a doctor will take a detailed medical history and conduct a focused physical exam. They will consider clues such as a recent viral infection, which might suggest mesenteric adenitis, or tenderness during a pelvic exam, which could point to pelvic inflammatory disease. A particular challenge is Crohn’s disease, which can often look very similar to appendicitis, especially if it’s the first time the person is having a flare-up.
Surgical Treatment of Appendicitis
Appendiceal neoplasms are rare tumors that can cause severe stomach pain. The most common types are gastroenteropancreatic neuroendocrine tumors (GEP-NETs), goblet cell carcinoma (GCC), colonic-type adenocarcinoma, and mucinous neoplasms.
GEP-NETs rarely spread, but if they do, it’s usually to the liver and lymph nodes. Treatment depends on the size of the tumor, with small tumors removed through an appendectomy and larger tumors requiring a more extensive surgery called right hemicolectomy.
GCC has features of both adenocarcinoma and neuroendocrine tumors. Patients with GCC need a comprehensive body scan and may require a right hemicolectomy.
Non-Hodgkin lymphoma, including MALT lymphoma, can start as acute appendicitis. Treatment involves an appendectomy and a full-body evaluation.
Adenocarcinoma of the appendix is a rare type of appendiceal neoplasm that often starts as acute appendicitis. The standard treatment is a right hemicolectomy, regardless of tumor size or lymph node involvement.
Appendiceal mucoceles are growths in the appendix that can mimic acute appendicitis. Treatment involves an appendectomy, but care must be taken not to rupture the cyst. Doctors also check for spread to the abdominal lining and may perform a biopsy.
Overall, the treatment for appendiceal neoplasms depends on the specific type of tumor and its characteristics.
What to expect with Appendicitis
An appendectomy, or a surgery to remove the appendix, is generally safe. A global study found that the death rate for appendicitis is 0.28%. However, in countries with less industry, the death rate can be between 1% to 4%. In industrialized countries, it’s a bit lower at 0.24%.
Certain factors can increase the chances of dying from appendicitis. These include being over 80 years old, having a weak immune system, severe heart disease, other health problems, previous inflammation of the appendix, and having taken antibiotics before.
If acute appendicitis is caught and treated promptly, patients can expect to recover in one to two days. However, if the disease is far along and has led to abscesses, inflammation of the lining of the abdomen, or sepsis, the recovery might take longer and could require more surgeries.
Possible Complications When Diagnosed with Appendicitis
The most common issue after an appendectomy (removal of the appendix) is an infection at the location of the surgery. This is particularly common in patients with a complex case of appendicitis. Infections can show up as abscesses (a swollen area within body tissue filled with pus) or infections in the wound after the operation. It’s also normal to experience hematomas (a solid swelling of clotted blood within the tissues) and pain post-surgery.
In nearly half of the patients who are treated without surgery, appendicitis can return. This recurrence rate can vary based on different studies and the duration of the monitoring period. In some cases, another appendectomy may be required to prevent the return of appendicitis.
One form of recurring appendicitis is stump appendicitis, where an incomplete appendectomy leaves a residual stump of the appendix, which inflames. This is often seen after the surgical treatment of complicated appendicitis, but can occur whenever the residual appendix is too long. A stump of less than or equal to 5 mm reduces the likelihood of stump appendicitis. An appendiceal stump can be effectively treated by removing it via an open or laparoscopic (minimally invasive) approach. If the appendiceal stumps are ruptured, surgical removal of a large portion of the intestines might be necessary.
Ignoring or not treating appendicitis or complicated appendicitis may lead to severe conditions like diffuse peritonitis and sepsis. These can cause significant health issues and sometimes can even be fatal.
Common Side Effects:
- Infection at surgical site
- Post-surgery abscesses
- Infections in the surgical wounds
- Hematomas
- Post-surgery pain
- Appendix inflammation (recurrence)
- Stump appendicitis
- Possible large-scale bowel surgery due to rupture
- Diffuse peritonitis (infection in the lining of the abdominal cavity)
- Sepsis (severe body-wide infection)
- Possible serious health concerns or even death
Recovery from Appendicitis
People who have simple appendicitis often go through a trouble-free recovery after surgery and don’t require antibiotics. On the other hand, those with more complex appendicitis typically need a 4-day antibiotic treatment. If wound complications, including infections, arise, they can be handled by making sure the wound is properly opened and cleaned, then packed. Even so, should issues like abscess formation or involvement of deeper tissue layers occur, the use of antibiotic therapy becomes crucial for correct patient management.
Preventing Appendicitis
Patients can generally go back to their regular activities within a week after surgery. However, during the first 4 to 6 weeks of recovery, it is important to avoid any hard work and heavy lifting.
