Appendicitis: one very serious bellyache

What triggers an appendicitis?

An infection of the appendix—appendicitis —can occur at any age, but is most common between the ages of 10 and 30. Appendicitis affects approximately one out of every 15 people, or approximately 7% of the U.S. population. It can result as an outgrowth of another—often a gastrointestinal viral— infection, or as a result of something blocking the entrance to the cavity that runs inside the appendix.

The danger from appendicitis is that the infected appendix will split open or burst, spreading infection to the peritoneum (the lining of the abdominal cavity). This results in peritonitis—a potentially life-threatening condition if not treated immediately with antibiotics .

In some instances, an abscess may develop, surrounding the infected appendix and preventing infection from spreading. However, the presence of an abscess usually cannot be identified definitively until surgery is performed. Accordingly, once detected, all cases of appendicitis are treated by surgery to remove the appendix.

Pain and tenderness, among other things

As Dr. Timothy Babineau, assistant professor of surgery at Harvard Medical School and attending general surgeon at Boston's Beth Israel-Deaconess Medical Center, points out, the first signs of appendicitis often mimic flu symptoms, including:

• nausea and/or vomiting
• loss of appetite
• fever
• constipation or diarrhea
• pain in parts of the abdomen, or in the back or rectum
• inability to pass gas
• abdominal swelling

However, the telltale sign of appendicitis is usually increasing tenderness and pain in the area known as the McBurney point—a point approximately half-way on a line between the protrusion of your hipbone and your navel. The pain worsens when moving, taking deep breathes, coughing, sneezing or touching the area.

Unfortunately, diagnosing appendicitis can be very difficult, because some or all of the symptoms are often missing. Even when all the symptoms are present, they are often misdiagnosed. Diagnosis can be especially difficult in the elderly and in young children, since they generally have only one or two symptoms and may not be able to articulate their pain. Appendicitis is also hard to diagnose in pregnant women, whose appendix—and thus, any pain from appendicitis—moves higher towards their rib cage as pregnancy progresses. Indeed, as Dr. Babineau points out, "Appendicitis is one of the more challenging diagnoses we make."

When appendicitis is suspected, a number of tests are ordered—X-rays, white blood cell counts, urinalysis to eliminate a urinary tract infection, and in some cases, a CT scan or ultrasound—to pinpoint the diagnosis before prescribing treatment. However, Dr. Babineau stresses that, "The most important diagnostic tool in diagnosing appendicitis is to get a careful history of the patient's symptoms and then conduct a thorough physical examination."

Only one way to treat appendicitis

Once diagnosed, the only treatment for appendicitis is an appendectomy—surgery to remove the appendix. Like many other types of surgery today, the generally preferred surgical method is the laparoscopic method. Small incisions are made in the abdomen, through which very small video and surgical equipment is passed. The surgeon then removes the appendix with the surgical tools, using the video monitor as a guide.

Laparoscopic appendectomies are generally preferred because they are less invasive and require smaller incisions. This results in shorter hospital stays (one day instead of two or three), quicker recovery (usually a number of days instead of more than a week), and less postoperative pain than with traditional "open" surgery.

In some instances however, open method appendectomies are still the chosen method, especially if the appendix has ruptured and spread infection to the abdomen. Here, the larger incision of the open surgical method is necessary to make sure that the abdomen is properly "cleaned" of infection. In addition, open method appendectomies are preferred when an abscess has been detected or is suspected.

No prevention, just quick action

There are presently no known measures you can take to prevent appendicitis. However, if you suspect that you or your child may have appendicitis, you should take the following steps:

• Seek out a medical examination immediately.
• Don't eat or drink anything until the examination is conducted, since emergency surgery may be required.
• Don't take pain medication prior to the examination, because it can mask symptoms, making diagnosis more difficult.

Recuperation and return to activities

Depending on whether or not rupture has occurred, what surgical method is used, and the age and condition of the patient, recuperation from an appendectomy will take anywhere from a few days to more than a week. During this period, rest will initially be prescribed, followed by a gradual resumption of normal activities. In some instances, you may be put on a liquid diet with immediate progression to a "soft" diet. But generally, patients return to their regular diet within a couple of days of surgery. Pain medication will be prescribed following surgery, as well as antibiotics if the appendix has ruptured. In virtually all cases, however, when treated immediately and properly, you can expect a full recovery with no major complications.