Appendicitis

National Digestive Diseases Information Clearinghouse

The appendix is a small, tube-like structure abdomen. Anyone can get appendicitis,
attached to the first part of the large intes- but it occurs most often between the ages
tine, also called the colon. The appendix of 10 and 30.
is located in the lower right portion of
National
the abdomen. It has no known function.
Institute of
Diabetes and Removal of the appendix appears to cause
Causes
Digestive The cause of appendicitis relates to block-
and Kidney no change in digestive function.
Diseases age of the inside of the appendix, known
Appendicitis is an inflammation of the as the lumen. The blockage leads to
NATIONAL
INSTITUTES
appendix. Once it starts, there is no effec- increased pressure, impaired blood flow,
OF HEALTH tive medical therapy, so appendicitis is and inflammation. If the blockage is not
considered a medical emergency. When treated, gangrene and rupture (breaking
treated promptly, most patients recover or tearing) of the appendix can result.
without difficulty. If treatment is delayed,
the appendix can burst, causing infection Most commonly, feces blocks the inside
and even death. Appendicitis is the most of the appendix. Also, bacterial or viral
common acute surgical emergency of the infections in the digestive tract can lead to

U.S. Department The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The
of Health and appendix is located in the lower right portion of the abdomen, near where the small intestine attaches to the large
Human Services intestine.
swelling of lymph nodes, which squeeze People With Special Concerns
the appendix and cause obstruction. This
Patients with special conditions may not
swelling of lymph nodes is known as lym-
have the set of symptoms above and may
phoid hyperplasia. Traumatic injury to
simply experience a general feeling of being
the abdomen may lead to appendicitis in a
unwell. Patients with these conditions
small number of people. Genetics may be a
include
factor in others. For example, appendicitis
that runs in families may result from a • people who use immunosuppressive
genetic variant that predisposes a person therapy such as steroids
to obstruction of the appendiceal lumen.
• people who have received a trans-
planted organ
Symptoms
Symptoms of appendicitis may include • people infected with the HIV virus

• pain in the abdomen, first around • people with diabetes

the belly button, then moving to the
• people who have cancer or who are
lower right area
receiving chemotherapy
• loss of appetite
• obese people
• nausea
Pregnant women, infants and young chil-
• vomiting dren, and the elderly have particular issues.

• constipation or diarrhea Abdominal pain, nausea, and vomiting are

more common during pregnancy and may
• inability to pass gas or may not be the signs of appendicitis.
Many women who develop appendicitis
• low fever that begins after other during pregnancy do not experience the
symptoms classic symptoms. Pregnant women who
• abdominal swelling experience pain on the right side of the
abdomen need to contact a doctor. Women
Not everyone with appendicitis has all in their third trimester are most at risk.
the symptoms. The pain intensifies and
worsens when moving, taking deep breaths, Infants and young children cannot commu-
coughing, or sneezing. The area becomes nicate their pain history to parents or doc-
very tender. People may have a sensation tors. Without a clear history, doctors must
called “downward urge,” also known as rely on a physical exam and less specific
“tenesmus,” which is the feeling that a symptoms, such as vomiting and fatigue.
bowel movement will relieve their discom- Toddlers with appendicitis sometimes have
fort. Laxatives and pain medications trouble eating and may seem unusually
should not be taken in this situation. sleepy. Children may have constipation,
Anyone with these symptoms needs to but may also have small stools that contain
see a qualified physician immediately. mucus. Symptoms vary widely among chil-
dren. If you think your child has appen-
dicitis, contact a doctor immediately.

2 Appendicitis
Older patients tend to have more medical Examination of the abdomen helps narrow
problems than young patients. The elderly the diagnosis. Location of the pain and
often experience less fever and less severe tenderness is important. Pain is a symptom
abdominal pain than other patients do. described by a patient; tenderness is the
Many older adults do not know that they response to being touched. Two signs,
have a serious problem until the appendix called peritoneal signs, suggest that the
is close to rupturing. A slight fever and lining of the abdomen is inflamed and sur-
abdominal pain on one’s right side are gery may be needed: rebound tenderness
reasons to call a doctor right away. and guarding. Rebound tenderness is
when the doctor presses on a part of the
All patients with special concerns and their abdomen and the patient feels more ten-
families need to be particularly alert to a derness when the pressure is released than
change in normal functioning and patients when it is applied. Guarding refers to the
should see their doctors sooner, rather than tensing of muscles in response to touch.
later, when a change occurs. The doctor may also move the patient’s legs
to test for pain on flexion of the hip (psoas
Diagnosis sign), pain on internal rotation of the hip
(obturator sign), or pain on the right side
Medical History and Physical when pressing on the left (Rovsing’s sign).
Examination These are valuable indicators of inflamma-
Asking questions to learn the history of tion but not all patients have them.
symptoms and a careful physical examina-
tion are key in the diagnosis of appendicitis. Laboratory Tests
The doctor will ask many questions—much Blood tests are used to check for signs of
like a reporter—trying to understand the infection, such as a high white blood cell
nature, timing, location, pattern, and sever- count. Blood chemistries may also show
ity of pain and symptoms. Any previous dehydration or fluid and electrolyte disor-
medical conditions and surgeries, family ders. Urinalysis is used to rule out a urinary
history, medications, and allergies are tract infection. Doctors may also order a
important information to the doctor. Use pregnancy test for women of childbearing
of alcohol, tobacco, and any other drugs age (those who have regular periods).
should also be mentioned. This informa-
tion is considered confidential and cannot Imaging Tests
be shared without the permission of the X rays, ultrasound, and computed tomogra-
patient. phy (CT) scans can produce images of the
abdomen. Plain x rays can show signs of
Before beginning a physical examination,
obstruction, perforation (a hole), foreign
a nurse or doctor will usually measure vital
bodies, and in rare cases, an appendicolith,
signs: temperature, pulse rate, breathing
which is hardened stool in the appendix.
rate, and blood pressure. Usually the phys-
Ultrasound may show appendiceal inflam-
ical examination proceeds from head to
mation and can diagnose gall bladder
toe. Many conditions such as pneumonia
disease and pregnancy. By far the most
or heart disease can cause abdominal pain.
common test used, however, is the CT scan.
Generalized symptoms such as fever, rash,
This test provides a series of cross-sectional
or swelling of the lymph nodes may point to
images of the body and can identify many
diseases that wouldn’t require surgery.

3 Appendicitis
abdominal conditions and facilitate diagno- for 4 to 6 weeks after surgery. Most people
sis when the clinical impression is in doubt. treated for appendicitis recover excellently
All women of childbearing age should have and rarely need to make any changes in
a pregnancy test before undergoing any their diet, exercise, or lifestyle.
testing with x rays.
Antibiotics and Other
In selected cases, particularly in women
when the cause of the symptoms may be
Treatments
either the appendix or an inflamed ovary or If the diagnosis is uncertain, people may
fallopian tube, laparoscopy may be neces- be watched and sometimes treated with
sary. This procedure avoids radiation, but antibiotics. This approach is taken when
requires general anesthesia. A laparoscope the doctor suspects that the patient’s symp-
is a thin tube with a camera attached that is toms may have a nonsurgical or medically
inserted into the body through a small cut, treatable cause. If the cause of the pain is
allowing doctors to see the internal organs. infectious, symptoms resolve with intra-
Surgery can then be performed laparoscop- venous antibiotics and intravenous fluids.
ically if the condition present requires it. In general, however, appendicitis cannot
be treated with antibiotics alone and will
require surgery.
Treatment
Occasionally the body is able to control
Surgery an appendiceal perforation by forming an
Acute appendicitis is treated by surgery to abscess. An abscess occurs when an infec-
remove the appendix. The operation may tion is walled off in one part of the body.
be performed through a standard small The doctor may choose to drain the abscess
incision in the right lower part of the and leave the drain in the abscess cavity for
abdomen, or it may be performed using a several weeks. An appendectomy may be
laparoscope, which requires three to four scheduled after the abscess is drained.
smaller incisions. If other conditions are
suspected in addition to appendicitis, they
may be identified using laparoscopy. In Complications
some patients, laparoscopy is preferable to The most serious complication of appen-
open surgery because the incision is small- dicitis is rupture. The appendix bursts
er, recovery time is quicker, and less pain or tears if appendicitis is not diagnosed
medication is required. The appendix is quickly and goes untreated. Infants, young
almost always removed, even if it is found children, and older adults are at highest
to be normal. With complete removal, any risk. A ruptured appendix can lead to
later episodes of pain will not be attributed peritonitis and abscess. Peritonitis is a
to appendicitis. dangerous infection that happens when
bacteria and other contents of the torn
Recovery from appendectomy takes a few appendix leak into the abdomen. In people
weeks. Doctors usually prescribe pain with appendicitis, an abscess usually takes
medication and ask patients to limit physi- the form of a swollen mass filled with fluid
cal activity. Recovery from laparoscopic and bacteria. In a few patients, compli-
appendectomy is generally faster, but limit- cations of appendicitis can lead to organ
ing strenuous activity may still be necessary failure and death.

4 Appendicitis
Hope Through Research For More Information
The National Institute of Diabetes and American Academy of Family Physicians
Digestive and Kidney Diseases (NIDDK) P.O. Box 11210
conducts and supports research into many Shawnee Mission, KS 66207–1210
kinds of digestive disorders, including some Phone: 1–800–274–2237
related to appendicitis. Email: [email protected]
Internet: www.aafp.org

American College of Surgeons

Points to Remember 633 North Saint Clair Street
• The appendix is a small, tube-like Chicago, IL 60611–3211
structure attached to the first part of Phone: (312) 202–5000
the colon. Appendicitis is an inflam- Fax: (312) 202–5001
mation of the appendix. Email: [email protected]
Internet: www.facs.org
• Appendicitis is considered a medical
emergency. American Society of Colon and Rectal
Surgeons (ASCRS)
• Symptoms of appendicitis include 85 West Algonquin Road
pain in the abdomen, loss of Suite 550
appetite, nausea, vomiting, consti- Arlington Heights, IL 60005
pation or diarrhea, inability to pass Phone: (847) 290–9184
gas, low-grade fever, and abdominal Fax: (847) 290–9203
swelling. Not everyone with appen- Email: [email protected]
dicitis has all the symptoms. Internet: www.fascrs.org
• Physical examination, laboratory National Library of Medicine—
tests, and imaging tests are used MEDLINEplus
to diagnose appendicitis. Internet: www.nlm.nih.gov/medlineplus
• Acute appendicitis is treated by
surgery to remove the appendix.

• The most serious complication of

appendicitis is rupture, which can
lead to peritonitis and abscess.

5 Appendicitis
National Digestive Diseases
Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389 or (301) 654–3810
Fax: (301) 907–8906
Email: [email protected]
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information

Clearinghouse (NDDIC) is a service of the
National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). The NIDDK
is part of the National Institutes of Health
under the U.S. Department of Health and
Human Services. Established in 1980, the
clearinghouse provides information about
digestive diseases to people with digestive
disorders and to their families, health care
professionals, and the public. NDDIC answers
inquiries, develops and distributes publications,
and works closely with professional and patient
organizations and Government agencies to
coordinate resources about digestive diseases.

Publications produced by the clearinghouse are

carefully reviewed by both NIDDK scientists
and outside experts. This fact sheet was
reviewed by Joshua Katz, M.D., George
Washington University Medical Center.

This publication is not copyrighted. The

clearinghouse encourages users of this fact
sheet to duplicate and distribute as many
copies as desired.
This fact sheet is also available at www.
digestive.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 04–4547

June 2004