What is acute appendicitis?

The appendix is a small pouch-like organ located at the junction where the small intestine meets the large intestine (colon). Acute appendicitis occurs when the appendix becomes inflamed and infected. This condition can cause severe abdominal pain and make the person feel very ill. In some cases, the inflamed appendix can rupture or burst.

What causes appendicitis?

Blockage of appendix by a small piece of hard faeces also known as a faecolith
Blockage of the appendix can also be caused by a tumour or parasites

What are the symptoms of appendicitis?

Some of the symptoms of appendicitis include:

Severe pain in the lower abdomen, particularly the right lower abdomen
Typically, the pain starts around the belly button and then moves down to the right lower abdomen
Loss of appetite
Feeling sick
Vomiting
High temperature
Loose stool
Abdominal bloating

How is appendicitis diagnosed?

Appendicitis is usually diagnosed by clinical assessment and examination and no further investigations may be needed. Blood tests may demonstrate raised infection and inflammation markers
When the diagnosis is unclear further tests may be performed to confirm the diagnosis. In you females an abdominal ultrasound may be the investigation of choice.
Alternatively, a CT scan is recommended for a definitive diagnosis

How is appendicitis treated?

If the appendix has not burst, also known as perforation, then appendicitis can be treated by antibiotics alone. However, there is always the risk of symptoms not improving or appendicitis recurring.
The other alternative to treating appendicitis is with surgery. This can be done as an open surgery where an incision is made at the site of the appendix on the right lower abdomen. The appendix is then removed through this cut. Alternatively, a key hole (laparoscopic) procedure can be performed to remove the appendix. During laparoscopic surgery 3 small cuts are made on the abdomen and a camera inserted into the abdomen to visualise the inside of the abdomen and the infected appendix is removed.
If the appendix is burst, a longer procedure with a bigger cut may be needed to remove the appendix and treat all the infection appropriately.

What are the consequences of not undergoing treatment?

Not undergoing treatment for appendicitis with antibiotics or an operation can result in the appendix bursting also known as perforation. This can make the patient very unwell with severe abdominal pain, fever and sepsis.

What are the risks surgery?

Infection
Pain
Intra or post procedure bleeding
Damage to other organs within the abdomen including the bowel, liver, stomach etc
Bowel perforation
Conversion to open surgery
Collections and sepsis
Leak at the site of joins known as an anastomotic leak leading to collections, infection and possible need for return to theatre
Complications related to a prolonged operation/anaesthetic including clots in the legs, lungs, brain or heart.

How long will I be in hospital and what is the recovery period and follow up?

Recovery is dependent on the severity of appendicitis and how it is has been treated
In the instances where antibiotics are used to treat appendicitis, intravenous antibiotics may be used for 2-3 days after which the patient can be discharged with tablet antibiotics as long as they are making clinical improvement.
Length of stay after surgery is dependent on the severity of appendicitis, whether there was perforation and if open surgery is performed.
Patients that undergo laparoscopic surgery for uncomplicated appendicitis, may be able to be discharged the day after surgery
Patients that undergo laparoscopic or open surgery for perforated appendicitis may require a prolonged course of intravenous antibiotics and may be in hospital for 5-7 days post-surgery.
Oral diet is usually built up immediately after surgery unless part of the bowel is also removed at the time of surgery
Patients may be sent home with tablet antibiotics if the appendicitis was very severe
Skin clips may be used on the abdominal incisions which will need to be removed 14 days from the day of surgery. Although in most instances absorbable stitches are used
No heavy lifting or strenuous activity for 6 weeks
Patients will be followed up 4-6 weeks after surgery