Appendicitis & Appendix Surgery (Appendicectomy)

What is appendicitis?

Appendicitis is inflammation of the appendix, a small narrow pouch attached to the beginning of the large intestine. It is one of the common causes of acute abdominal pain requiring surgical assessment.

Appendicitis usually develops when the opening of the appendix becomes blocked and inflammation progresses within it. If untreated, the appendix may occasionally become gangrenous or perforate, allowing infection to spread within the abdomen. This can lead to an appendicular abscess or peritonitis.

The pattern and severity vary considerably between patients, so diagnosis should not be based on one symptom alone.

What symptoms can appendicitis cause?

A typical episode may begin with vague discomfort around the umbilicus that subsequently becomes more prominent in the right lower abdomen. Loss of appetite, nausea, vomiting and fever may accompany the pain.

However, appendicitis does not always follow the classic pattern. Children, older adults, pregnant women and patients with an unusually positioned appendix may have less typical symptoms.

Other abdominal, urinary and gynaecological conditions can also mimic appendicitis. Persistent or worsening abdominal pain therefore needs proper clinical assessment rather than self-diagnosis.

How is appendicitis diagnosed?

Diagnosis begins with the history and abdominal examination.

Blood tests may show evidence of inflammation, although normal blood tests do not by themselves exclude appendicitis. Urine testing may help distinguish urinary causes of abdominal pain.

Ultrasound is commonly useful, especially in younger patients and pregnancy. CT scanning provides greater diagnostic detail in many adults when the diagnosis is uncertain. MRI may be used in selected situations, particularly when avoiding ionising radiation is important.

The appropriate investigation depends on age, pregnancy status, clinical findings, duration of symptoms and the likelihood of alternative diagnoses.

Does every patient with appendicitis need an operation?

Appendicectomy remains the standard definitive treatment for many patients with acute appendicitis.

There is increasing evidence that carefully selected patients with imaging-confirmed uncomplicated appendicitis may sometimes be managed initially with antibiotics. This is not suitable for everyone. Failure of antibiotic treatment, recurrent appendicitis and subsequent need for surgery remain possibilities.

Factors such as a faecolith, recurrent symptoms, difficulty accessing urgent medical care, immune suppression or concern about complicated disease may make definitive surgery preferable.

A well-formed appendicular abscess or inflammatory mass is a different clinical situation. Some patients may initially be treated with antibiotics, observation and occasionally image-guided drainage, with subsequent management individualised according to recovery and clinical findings.

The decision should therefore be based on the particular patient's examination, imaging, severity of disease and overall health.

Laparoscopic appendicectomy

When surgery is required, laparoscopic appendicectomy is usually preferred where appropriate expertise and facilities are available.

The operation is performed under general anaesthesia. Small abdominal incisions are made and carbon dioxide is used to create working space within the abdomen. A camera allows the appendix and surrounding structures to be examined.

The appendix is separated from its blood supply, divided safely at its base and removed. Any contamination or collection is dealt with as clinically appropriate.

In some situations an open operation may be safer. A surgeon may also begin laparoscopically and convert to an open incision if severe inflammation, adhesions, anatomy or another unexpected finding makes that necessary. Conversion is a safety decision rather than a failure of the laparoscopic operation.

What if the appendix has perforated?

Perforated or gangrenous appendicitis may produce localised pus, an intra-abdominal abscess or more widespread peritonitis.

These patients may require more intensive antibiotic treatment, drainage of infected material and a longer hospital stay. The exact management depends on whether the infection is localised or generalised and on the patient's overall condition.

Recovery is usually longer than after uncomplicated appendicitis.

What happens after appendicectomy?

After uncomplicated laparoscopic surgery, oral fluids and food are usually restarted as tolerated and patients are encouraged to mobilise early.

Many patients can leave hospital within a short period once pain is controlled, they can tolerate oral intake and there is no clinical concern. Patients with perforation, significant infection or other medical problems may need a longer stay.

The removed appendix is generally sent for histopathological examination. This confirms the diagnosis and can occasionally identify unexpected pathology.

Patients should follow the surgeon's advice regarding wound care, bathing, driving, return to work and strenuous physical activity.

When should urgent medical attention be sought?

Severe or progressively worsening abdominal pain, particularly when associated with vomiting, fever or marked tenderness, should be assessed promptly.

Following surgery, increasing abdominal pain rather than gradual improvement, persistent vomiting, increasing abdominal distension, high fever, pus or significant redness around a wound, difficulty breathing, fainting or other major deterioration should prompt urgent medical review.

This information is intended for general patient education and does not replace examination and individual medical advice.