Appendicitis

Appendicitis is a condition in which your appendix gets inflamed. The appendix is a small pouch attached to the large intestine.

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Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, a tumor or a parasite in rare cases.

Symptoms

The symptoms of appendicitis can vary. It can be hard to detect appendicitis in young children, older people, and women of childbearing age.

The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever.

The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts.

Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include:

Chills and shaking
Hard stools
Diarrhea
Fever
Nausea and vomiting

Exams and Tests

Your health care provider may suspect appendicitis based on the symptoms you describe.

Your provider will do a physical exam.

If you have appendicitis, your pain will increase when your lower right belly area is pressed.
If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles.
A rectal exam may find tenderness on the right side of your rectum.

A blood test will often show a high white blood cell count. Imaging tests that may help diagnose appendicitis include:

CT scan of the abdomen
CT scan of the abdomen
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Ultrasound of the abdomen
Ultrasound of the abdomen
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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Treatment

Most of the time, a surgeon will remove your appendix as soon as you are diagnosed.

If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away.

The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.

Outlook (Prognosis)

Most people recover quickly after surgery if the appendix is removed before it ruptures.

If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as:

An abscess
Blockage of the intestine
Infection inside the abdomen (peritonitis)
Infection of the wound after surgery

When to Contact a Medical Professional

Call your provider if you have pain in the lower-right portion of your belly, or other symptoms of appendicitis.

Open References

References

Cole MA, Huang RD. Acute appendicitis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 83.

Rosenthal MD, Sarosi GA. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 120.

Sifri CD, Madoff LC. Appendicitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 78.

Smith MP, Katz DS, Lalani T, et al. ACR appropriateness criteria right lower quadrant pain -- suspected appendicitis. Ultrasound Q. 2015;31(2):85-91. PMID: 25364964 pubmed.ncbi.nlm.nih.gov/25364964/.

Appendicitis
Animation

Appendectomy
Animation

Anatomical landmarks adult - front - illustration
There are three body views (front, back, and side) that can help you to identify a specific body area. The labels show areas of the body which are identified either by anatomical or by common names. For example, the back of the knee is called the “popliteal fossa,” while the “flank” is an area on the side of the body.
Anatomical landmarks adult - front
illustration
Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Appendectomy - series
Presentation

<strong>Appendectomy - series</strong><p>The appendix is a small, finger-shaped pouch of intestinal tissue located between the small intestine (cecum) and large intestine (colon).</p>

<strong>Indications</strong><p>If the appendix becomes infected it must be surgically removed before it ruptures and spreads infection to the entire abdominal space. Symptoms of acute appendicitis include pain in the lower right side of the abdomen, fever, reduced appetite, nausea or vomiting. Before surgery, the doctor will perform a physical exam. The physician will check the abdomen for tenderness and tightness and check the rectum for tenderness and an enlarged appendix. In women, a pelvic exam is also performed to exclude pain caused by the ovaries or uterus. Additionally, blood tests and x-rays may also be performed. There is no test to confirm appendicitis and the symptoms may be caused by other illnesses. The doctor must diagnose from the information you report and what he sees. During appendectomy surgery, even if the surgeon finds that the appendix is not infected (which can happen up to 25% of the time), he will thoroughly check the other abdominal organs and remove the appendix anyway.</p>

<strong>Incision</strong><p>Depending upon the circumstances of the individual patient, an appendectomy can be performed in one of two ways, through an open incision or with a laparoscope. In the open technique, an incision is made in the lower right side of the abdomen, through the skin, muscle wall, and peritoneum. The appendix is located and then carefully freed from the surrounding structures and removed. In the laparoscopic technique, several small incisions are made in the abdomen. In one incision a laparoscope is inserted. The laparoscope has a tiny lens to which a TV camera is attached. The appendectomy is performed by the surgeon while looking at the TV monitor. Small instruments are inserted in the other incisions and used to remove the appendix.</p>

<strong>Procedure</strong><p>If a pocket of infection has formed, or the appendix has ruptured, the abdomen will be thoroughly washed out during surgery. The surgeon may then leave the skin open and allow it to heal together on its own, to allow the infection to drain, or less frequently, put in a small drainage tube.</p>

<strong>Aftercare</strong><p>Recovery from a simple appendectomy is usually complete and rapid. Most patients can go home the day after the operation, and resume normal diet and activities within one to two weeks. If the appendix has developed an abscess or has ruptured, the recovery may be slower and more complicated, requiring use of medications to treat the infection (antibiotics). Living without an appendix causes no known health problems.</p>

Appendicitis - illustration
The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.
Appendicitis
illustration

Appendicitis
Animation

Appendectomy
Animation

Anatomical landmarks adult - front - illustration
There are three body views (front, back, and side) that can help you to identify a specific body area. The labels show areas of the body which are identified either by anatomical or by common names. For example, the back of the knee is called the “popliteal fossa,” while the “flank” is an area on the side of the body.
Anatomical landmarks adult - front
illustration
Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Appendectomy - series
Presentation

Appendicitis - illustration
The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.
Appendicitis
illustration

Self Care

Tests for Appendicitis

Review Date: 4/20/2021

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Appendicitis

Tumor

Symptoms

McBurney point

Exams and Tests

CT scan of the abdomen

Ultrasound of the abdomen

Treatment

Remove your appendix

Abscess

Outlook (Prognosis)

When to Contact a Medical Professional