Appendicitis

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.

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 immune system is fighting something else. This is because the appendix contains a lot of immune system cells so the tissue may then swell up too. Gut flora ( bacteria) could also be a factor: The appendix is home to a lot of these bacteria 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 inflammation 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 infection 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 infection 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 inflammation 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 diagnosis, 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 infection.

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 diagnosis 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 inflammation 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 antibiotics 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 antibiotics instead, depending on the circumstances. Even then, the infection 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 antibiotics 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.

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.

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.