Appendicitis

The Facts

A sudden inflammation or swelling of the appendix is called appendicitis. The appendix is a tube-like structure that branches off where the large intestine (colon) begins. It's pencil-thin and normally about 4 inches (7 cm) long. For many years, scientists were unsure of the function the appendix had in the body. Now we know it helps make immunoglobulins, substances that are part of the immune system. Immunoglobulins are made in many parts of the body. Thus, removing the appendix does not seem to result in problems with the immune system.

Appendicitis is rarely fatal these days, due to today's use of antibiotics and safe surgery. The condition affects one in 15 people and strikes men more than women. It hardly ever affects children under age three; it occurs most commonly between 10 and 30 years of age.

Causes

Inflammation of the appendix is usually the result of blockage causing an infection. The appendix is open at one end where it connects to the large intestine. Appendicitis may occur when the appendix is blocked by hardened masses of feces or a foreign body in the intestine. This blockage can cause inflammation of the appendix directly and can encourage bacterial infection.

Blockage may also occur if lymph nodes in the appendix swell. Less common causes of blockage are vegetable and fruit seeds, stomach worms, and thickened barium from prior X-rays.

In seniors, appendicitis is occasionally caused by a tumor (cancer) of the colon.

Symptoms and Complications

Early symptoms of acute appendicitis may include:

• constipation, diarrhea, or gas
• dull pain beginning around the navel, turning to sharp pain in the lower right portion of the abdomen - this takes place over about two hours
• loss of appetite
• low fever (99° to 102°)
• nausea and vomiting
• tenderness when pressed in the lower right front abdomen. Rebound tenderness is a good indicator of appendicitis - this means it hurts more when the finger is pulled back suddenly from the abdomen than it does when it is pressed forward

These are the classic symptoms common in adolescents and young adults. In younger children, pain is less localized, and there may be no tender points. In older adults, there is generally less pain.

Symptoms of more advanced appendicitis include:

• abdominal swelling and rigidity
• pain on the right side of the abdomen when pressed on the left side

These are both signs that inflammation has spread to the abdominal cavity or peritoneum. Left untreated, appendicitis will proceed from mild to severe symptoms. When the infection has reached this stage, it's called peritonitis, which is life-threatening, and a doctor should be seen immediately.

The great danger in appendicitis is rupture or perforation of the appendix. All the inflammatory agents and bacteria in the appendix spill out into the abdominal cavity, causing severe peritonitis. Sometimes there's mild peritonitis even before the appendix ruptures.

Occasionally, a mass of scar tissue forms an abscess around the appendix. In some ways, this reduces risk, since it insulates the abdomen from the dangerous pus inside. It tends to complicate surgery, however, often requiring two operations.