At a glance

  • Appendicitis is an inflammation or infection of the appendix.
  • Common symptoms include abdominal (belly) pain, nausea, vomiting and fever.
  • If the infection spreads to the abdominal cavity, it can be life-threatening.
  • Because of this, the appendix is usually surgically removed as soon as possible.
  • Treatment with antibiotics is sometimes enough, though.


Photo of a boy at a medical examination

Appendicitis is an inflammation or of the appendix. Signs of this disease include abdominal (belly) pain, nausea and fever. If an abscess (pocket of pus) forms or the spreads to the abdominal cavity, it can cause serious complications such as blood circulation problems or sepsis (blood poisoning). Because of this, the appendix is usually removed through surgery as quickly as possible. This typically involves a minimally invasive operation through small cuts in the skin. Treatment with is sometimes enough, though.

The appendix is a tube that is lined with a mucous membrane on the inside. It hangs off the end of a pouch at the beginning of the large intestine (the cecum) and looks a bit like an earthworm. Because of this, it is also known as the "vermiform appendix" (the word "vermiform" comes from Latin and means "worm-shaped").

Illustration: The appendix hangs off the end of the cecum


Typical symptoms of appendicitis include:

  • Abdominal pain, especially in the lower right part of the belly, but at first also often in the upper belly or around the belly button
  • Loss of appetite
  • Nausea or vomiting
  • Constipation or (less commonly) diarrhea
  • Fever

But appendicitis might cause other symptoms too: Pregnant women often have pain in the upper abdomen. The symptoms may be mild in children and older people.

Less typical pain in the belly and problems peeing can also sometimes occur. So it's not always easy to spot appendicitis.

Causes and risk factors

It is not known what exactly causes appendicitis. The risk is thought to be greater if the appendix has a kink in it or if hardened stool (poo) or parasites (worms) get in there.

The appendix might also become inflamed when your is fighting something else. This is because the appendix contains a lot of cells so the tissue may then swell up too. Gut flora () could also be a factor: The appendix is home to a lot of these that help digestion.


Appendicitis is one of the most common acute illnesses in the abdomen that needs to be treated.

About 7% of women and girls, and almost 9% of men and boys, will have appendicitis during their lifetime. It is most common in children and teenagers. Overall, around 1 in 1,000 people get appendicitis each year. More than 135,000 appendix operations are performed every year in Germany.


Appendicitis usually comes suddenly, causing pain, nausea or fever. The pain often begins in the upper abdomen (upper belly), gets worse within a few hours, and moves down to the lower right abdomen.

Doctors describe appendicitis as either uncomplicated or complicated:

  • In uncomplicated appendicitis, the appendix is simply inflamed. It is now believed that this type can get better without treatment. But the appendix is usually surgically removed anyway, to prevent the from getting worse and causing more serious problems.
  • About 2 to 3 out of 10 cases of appendicitis are “complicated.” Then pus is produced and may build up in an abscess (pocket of pus), for instance. The with pus can spread to nearby tissue and destroy the appendix. If the appendix ruptures (tears or bursts), then pus, wound fluid and bacteria get into the abdominal cavity. This can lead to life-threatening complications so it has to be treated quickly.

Children and older people are more likely to have complicated appendicitis.

In very rare cases, the appendix becomes chronically inflamed and causes symptoms time and again or over longer periods. That might be caused by a chronic inflammatory bowel disease like Crohn's disease.


If the appendicitis spreads to the abdomen, the pain in the belly may actually get better for a short time before getting worse again. The following signs might also arise as soon as the spreads to the abdomen:

  • A hard tummy
  • Being bent over in pain with your legs tucked up
  • Pale skin
  • High pulse
  • Cold sweats
  • Dizziness or even unconsciousness

If complicated appendicitis isn't treated quickly, the risk of life-threatening blood circulation problems and sepsis (blood poisoning) increases.

After the appendix is removed, scar tissue may stick to the tissue around it and form adhesions. That can lead to abdominal pain or bowel problems.


It is often difficult to spot appendicitis because the symptoms can vary quite a lot from person to person. So it can be a good idea to see a doctor if you have pain in your belly for a number of hours.

The doctor will first ask you where exactly your belly hurts and whether you have any other symptoms like fever, constipation or vomiting. They will also feel your tummy. If it hurts more when they put pressure on certain areas, that might be another sign of appendicitis – or a sign that the peritoneum (the membrane lining the abdominal cavity) is irritated or infected. This serious complication is called peritonitis.

Asking these questions and doing a physical examination is usually not enough to make a definite , though. Because of this, other examinations are usually needed – particularly an ultrasound scan of the abdomen. The ultrasound shows whether the appendix is swollen and whether there's a build-up of pus or fluid. To spot these kinds of complications better, a CT scan or MRI scan might be done afterwards too. Your blood will also be tested for signs of an .

Even if appendicitis has already been diagnosed, the symptoms will be checked regularly and some of the examinations will be repeated – especially in young children who aren't old enough to describe their symptoms.


The inflamed appendix is usually removed within 24 hours of the using a type of minimally invasive surgery (keyhole surgery) called laparoscopy. Here the surgeon makes small cuts in the wall of your belly and then inserts instruments and a camera into the belly through thin tubes. Any other infected tissue can be removed that way, too. Sometimes the appendix is removed using open surgery instead, for instance if the has already spread. Then a bigger cut has to be made in the wall of the belly.

About 30 minutes before the surgery you will usually be given an injection of to keep the wound from being infected. Antibiotics are typically only used in the days after surgery if you had complicated appendicitis.

Sometimes surgery isn’t needed. Uncomplicated appendicitis can be treated with instead, depending on the circumstances. Even then, the will usually go away without any complications. But there’s an increased risk of getting appendicitis again and needing surgery then.

If collections of pus have already formed, appendicitis can sometimes be treated with and surgery is not needed at first. Then a thin tube is inserted into the abdomen to drain the pus. But if the appendicitis is complicated, surgery is recommended within a short time.

Everyday life

It is not possible to say exactly how long you will stay in hospital after surgery. You should expect to be in for two to three days. But some people stay in hospital for up to a week, or longer if there are complications or they have other severe medical conditions.

It is also hard to say how soon you will be able to go back to work or school and go about your daily activities again. Some people only need about a week. But people who, for instance, do physically strenuous jobs might need a good month until they can go back to work fully.

Further information

When people are ill or need medical advice for themselves or a child, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on February 1, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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