Appendicitis: Symptoms, diagnosis and treatments

Appendicitis is an inflammation of the appendix. This small, fingerlike tube sits near the lower right side of the large intestine. It usually becomes inflamed because of an infection or an obstruction in the digestive tract. If untreated, an infected appendix can burst and spread the infection throughout the abdominal cavity and into the bloodstream.

Symptoms

Symptoms of appendicitis include:

• abdominal pain, usually starting just above the belly button and then moving to the right lower side of the abdomen
• nausea
• vomiting
• abdominal swelling
• pain when the right side of the abdomen is touched
• low-grade fever
• inability to pass gas
• change in normal bowel pattern

Diagnosis

Many things can cause abdominal pain. To make a diagnosis, your doctor will ask you about your current and past health. He or she will be especially interested in any digestive symptoms and your most recent bowel movements: their timing, frequency, character (watery or hard), and whether the stool was streaked with blood or mucus.

Your doctor will examine you and check for pain in your lower right abdomen. In children, the doctor will look to see whether the child holds his or her hands over the navel when asked where it hurts. In an infant, flexed hips (knees held toward the chest) and a tender abdomen can be important clues to the diagnosis.

After the physical examination, your doctor will likely recommend that you have blood tests to check for signs of infection and a urinalysis to rule out a urinary tract problem. Your doctor may order an ultrasound or CT scan to help confirm the diagnosis. In very young children, a chest X-ray may be needed to rule out pneumonia.

Treatment

The standard treatment is removing the appendix. The surgery, called an appendectomy, should be done as soon as possible before the appendix ruptures. If appendicitis is strongly suspected, a surgeon will often advise removing the appendix even if an ultrasound or CT scan cannot confirm the diagnosis. The surgeon's recommendation to operate reflects the danger of a ruptured appendix: It can be life-threatening, while an appendectomy is a relatively low-risk operation.

Laparoscopic (keyhole) surgery to remove the appendix is often preferred over opening the belly because the average length of stay in the hospital is shorter and recovery is quicker.

People usually are given antibiotics intravenously (into a vein) during surgery. The antibiotic is continued until the day after surgery. If the appendix ruptured, the person will need to take antibiotics for a week or more.