Appendicitis

As far as anyone can tell, the appendix serves no particular purpose in the body. While your other organs are busy keeping you alive, this small, pinkish, finger-length abdominal sac seems content to just take up space. But every once in awhile, the appendix can be a matter of life and death. If the organ becomes swollen and inflamed -- a condition called appendicitis -- you'll need an emergency operation to have it removed.

Surgeons have been successfully performing appendectomies for more than 100 years, and it is now the most common type of emergency abdominal surgery. Every year, several hundred thousand Americans have the operation. Almost all of them leave the hospital within a few days and get back to work within a couple of weeks. And aside from a minor scar, life proceeds as usual. It's hard to miss an organ that never really did anything.

What is appendicitis?

The appendix sits like a cul-de-sac at the spot where the small intestine meets the large intestine -- an intersection that sees a lot of traffic. If undigested food (or anything else) clogs the opening of the appendix, the organ can fill with a mucus-like fluid and expand like a small balloon. It also becomes inflamed and extremely tender. (Bacteria and viruses can also cause an inflammation in the area.) If the pressure from the blockage cuts off the appendix's blood supply, parts of the organ will start dying, providing an excellent feeding ground for bacteria.

Of course, the appendix can't expand forever. If it's not removed, it will eventually burst, potentially scattering bacteria throughout your abdominal cavity. When the burst appendix ruptures, it can cause pus to collect in one part of the abdomen, forming a localized abscess. Worse, if you develop a life-threatening illness called peritonitis, abscesses may crop up throughout the abdominal cavity.

What are the symptoms of appendicitis?

The first symptom of appendicitis is usually nausea, then pain or a vague, uncomfortable feeling around the navel. Things often go downhill rapidly from there. In acute appendicitis, intense pain builds in the lower right side of the abdomen. Many people also experience a loss of appetite (anorexia), vomiting, a feeling of tenderness in the abdomen, or a slight fever.

In some people, the appendix sticks out in an unusual place or an odd angle. In these cases, appendicitis can cause other symptoms such as pain in the sides or the back, pain during urination, or pain in the upper left side of the abdomen.

If you have these symptoms, go to an emergency room immediately. Appendicitis is a medical emergency.

Who is at higher risk for appendicitis?

Appendicitis affects 7 percent of the U.S. population over a lifetime, with most cases occurring between 10 and 30 years of age. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the disease is most common among teens and young adults, males more often than females, and Latinos more than other groups, although no one knows why.

Appendicitis in the elderly may be difficult to diagnose because they don't experience the typical symptoms of the illness. Appendicitis should be considered, however, in any elderly patient who still has an appendix and who develops sudden abdominal pain.

Keep in mind that appendicitis can strike any person at any age. If you have an appendix, it can happen to you.

How is appendicitis treated?

Appendicitis is usually sudden in its onset and progresses rapidly. After a diagnosis of appendicitis, most people have immediate surgery to remove the appendix, an operation called an appendectomy. Sometimes surgeons drain the abdominal cavity and put the patient on antibiotic therapy, then do the appendectomy weeks later.

Surgeons can remove the appendix in two different ways. With an "open" operation, a surgeon will make a small incision in the right lower quarter of the abdomen and cut out the appendix (a muscle-splitting operation). A larger incision may be required if the appendix has burst. The surgeon then seals the incision with sutures or small staples.

The other, less-invasive option is a laparoscopic surgery. In this operation, a surgeon will insert a thin metal tube equipped with a miniscule television camera through a tiny hole in your belly button. An absorbable gas is injected into the abdomen to help make room for the laparoscope and surgical tools. Guided by the camera, the surgeon then guides surgical instruments through two other very small openings and removes the appendix.

Both types of operation are performed under general anesthesia. You'll be asleep during the whole process and won't feel any pain.

What are the differences between the two types of surgery?

For many types of operations, laparoscopic surgery is a big improvement over traditional scalpel-and-suture surgery. The laparoscopic operation generally allows a faster recovery and causes less scarring. However the type of surgery necessary with appendicitis depends on the condition of the appendix and the surrounding area. If your appendix has ruptured, the infection has spread beyond the appendix, or an abscess is present, a larger incision may be necessary. Consult with your surgeon about the right operation for you.

Recently, more attention is being paid to intravenous antibiotic treatment alone as a potential substitute for surgery. The Harvard Health Blog reported on a study from Nottingham University in England, which found that antibiotics alone successfully treated appendicitis 63 percent of the time -- although 20 percent of people treated with antibiotics alone ended up back in the hospital. The study concluded that use of antibiotics alone "merits consideration."

Can appendicitis be prevented?

Although medical data is sparse, some research has found that a high-fiber diet may help prevent appendicitis in children. Children who eat a low-fiber diet high in refined carbohydrates are at greater risk for appendicitis, possibly because of the increased risk of obstruction at the appendix, according to the Annals of Emergency Medicine.

Can I stay healthy without an appendix?

Absolutely. There's no evidence that a person's health suffers after an appendectomy. In fact, the operation may actually make you healthier. Some years back, Greek researchers found that an appendectomy seemed to cut the risk of ulcerative colitis by almost 70 percent. Finally -- a sign that the appendix actually does something.

Doctors don't recommend an appendectomy unless you actually have appendicitis. Nonetheless, some tourists planning a long ocean cruise are so afraid of appendicitis that they've actually asked doctors to remove a healthy appendix, according to Namir Katkhouda, chief of laparoscopic surgery at the University of Southern California department of surgery. They're worried because an unusually sudden inflammation of the appendix, left untreated, could kill them, says Katkhouda, who turns down patients who ask for the unnecessary surgery. His advice to anyone who gets appendicitis far from home? Don't panic. The National Institute of Diabetes and Digestive and Kidney Diseases says that if surgery is not available, some research suggests antibiotics combined with a liquid or soft diet may effectively treat appendicitis without a patient having to undergo surgery. As for making yourself more comfortable: "Put ice on your belly until you get medical help," Katkhouda says.

References

Acute Appendicitis: Review and Update. American Academy of Family Physicians/American Family Physician.

Harvard Health Blog, Antibiotics instead of surgery safe for some with appendicitis, http://www.health.harvard.edu/blog/antibiotics-instead-of-surgery-safe-for-some-with-appendicitis-201204114588

Acute Appendicitis in Children. Rothrock G et al. Annals of Emergency Medicine. Vol. 36:39-51.

Mayo Clinic. Appendicitis.

National Institute of Diabetes and Digestive and Kidney Diseases. Appendicitis.

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