Appendicitis

Appendicitis is inflammation of the appendix, a small pouch extending from the large intestine in the lower right abdomen. It usually happens when the appendix becomes blocked, leading to swelling, infection, and a build-up of pus. This often causes pain that starts around the navel and then moves to the lower right abdomen. Without prompt treatment, the appendix may rupture, spreading infection within the abdomen (peritonitis), which requires emergency surgery.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Appendicitis

The symptoms of appendicitis vary based on the stage of inflammation. Common signs include:

Abdominal pain

Typically begins near the navel before shifting to the lower right abdomen. Pain often worsens with movement, coughing, or deep breathing.
Loss of appetite

Many individuals lose interest in eating soon after pain begins as the body responds to inflammation.
Nausea and vomiting

Often follow the onset of pain. Vomiting may provide brief relief but does not resolve the condition.
Low-grade fever

Temperature usually rises as the body fights infection. Higher temperatures may indicate rupture or abscess formation
Rebound tenderness

Pain worsens when pressure on the abdomen is released quickly, suggesting peritoneal irritation from inflammation.
Migration of pain

Pain initially felt around the navel shifts to the right lower abdomen as inflammation progresses, a common diagnostic sign.
Constipation or diarrhoea

Changes in bowel habits may occur, depending on how inflammation affects the intestines. Either symptom can develop due to altered bowel motility.

Causes and Risk Factors

Appendicitis occurs when the appendix becomes blocked, leading to bacterial overgrowth, infection, and inflammation. Several factors contribute to this condition:

Obstruction

Blockage of the appendix can happen due to hardened stool (fecalith), enlarged lymphoid tissue, or foreign bodies. This blockage prevents drainage, creating an environment for bacterial proliferation.

Family history

A genetic predisposition may increase susceptibility. Individuals with first-degree relatives who have had appendicitis face a slightly higher risk of developing the condition.

Dietary factors

Low-fibre diets may contribute to fecalith formation, potentially increasing the risk of appendicitis.

Diagnostic Methods

Physical examination

Your doctor checks for tenderness in the lower right abdomen, particularly a specific point often linked with appendicitis. They may also observe how pain changes to movement, pressure, and release — reactions that can signal irritation of the abdominal lining.
Blood tests

A blood sample helps detect signs of infection and inflammation, such as an elevated white blood cell count and increased C-reactive protein (CRP) levels. These results support the diagnosis but aren’t unique to appendicitis.
Urinalysis

A urine test helps rule out other causes of abdominal pain, like kidney stones or urinary tract infections. While it can’t confirm appendicitis, it helps rule out other possible causes.
Imaging studies

Ultrasound is often used to detect an inflamed appendix and surrounding changes. If the results are unclear, a CT scan provides more detailed images, indentifying signs such as an enlarged appendix or fluid build-up. An MRI may be used where other imaging methods are inconclusive.

Treatment Options

The approach to treating appendicitis depends on the severity of inflammation. The primary goal is to remove the infected appendix and prevent complications.

Non-Surgical Treatment

Antibiotics: In some cases of uncomplicated appendicitis, a course of broad-spectrum antibiotics may help resolve the infection without surgery. This approach can help resolve symptoms and may be an option for patients who are not suitable for immediate surgery. However, careful follow-up is required to monitor for any signs of recurrence or worsening.
Conservative management: If an appendiceal mass or abscess has developed, the initial treatment may involve antibiotics and drainage rather than immediate surgery. Once the infection is controlled, an interval appendectomy may be performed to remove the appendix after symptoms have resolved. During this period, the patient is closely monitored to prevent further complications.

Surgical Treatment

Laparoscopic appendectomy: This minimally invasive procedure involves making small incisions in the abdomen to insert a camera and surgical instruments. The appendix is located, tied off at its base, and removed. Laparoscopic surgery typically results in less post-operative pain, shorter hospital stays, and quicker recovery compared to open surgery.
Open appendectomy: In this traditional approach, a single incision is made in the lower right abdomen to access and remove the appendix. This method is often used for complicated cases, such as perforated appendicitis with widespread infection, or when laparoscopic surgery is not an option.

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Prevention and Management

While there’s no guaranteed way to prevent appendicitis, maintaining a healthy lifestyle may help reduce the risk. Eating a high-fibre diet supports good digestion and helps prevent constipation, which can contribute to blockages in the appendix. Staying well-hydrated also promotes digestive health and reduces the chance of obstruction. Seeking prompt medical attention for persistent abdominal pain – especially when accompanied by fever, nausea, or vomiting – allows for early diagnosis and timely treatment. After treatment, following post-surgical care instructions ensures proper healing and minimises the risk of complications. Regular medical check-ups can help detect digestive issues early, reducing the risk of further problems.

Frequently Asked Questions (FAQ)

Can appendicitis occur without severe pain?

Yes, some individuals may experience mild or atypical symptoms, especially young children, older adults, and pregnant women. In these cases, discomfort may be vague or mistaken for indigestion or other abdominal issues.

Can appendicitis be resolved without treatment?

In rare cases, mild appendicitis symptoms may subside temporarily, but the condition usually worsens over time. Without proper treatment, the appendix can rupture, leading to serious complications. Medical evaluation is essential to determine the right course of action.

Can appendicitis affect other organs?

Yes, if left untreated, a ruptured appendix can cause peritonitis (infection of the abdominal lining) or an abscess. The infection may spread to surrounding organs like the intestines or bladder.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)

Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.

Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.

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