What is appendicitis?
Appendicitis is one of the most common diseases: More than seven out of every hundred people suffer from an inflamed appendix at some point in their lives. Around 12,000 Swiss people are admitted to hospital every year for an appendectomy. Strictly speaking, however, it is an inflamed appendix (medically known as the appendix). This worm-like appendage at the beginning of the large intestine can become inflamed, which is then called appendicitis. The appendix is popularly known as the cecum because this small structure extending from the large intestine ends blindly, i.e. corresponds to a piece of intestine that ends blindly. What doctors refer to as appendicitis is commonly known as appendicitis.
Appendicitis can occur at any age; however, more than two thirds of those affected fall ill before the age of 30, especially at school age. An inflamed appendix is more common in boys and men than in girls and women, whereas appendicitis rarely occurs in small children.
Causes: How does appendicitis develop?
The appendix attached to the appendix is usually eight to ten centimeters long, but can also be significantly longer or shorter. This appendix is closed at one end, forming a dead end; the other end of the appendix merges into the coecum, which is the beginning of the large intestine. This passage can become blocked, for example by hardened lumps of stool, so-called fecal stones. In rarer cases, fruit stones or other foreign bodies can also be the cause. If such an obstruction has formed or if the passage to the appendix is blocked in some other way, the secretions present in the appendix accumulate. They are no longer removed, bacteria multiply and the immune system reacts with inflammation.
Symptoms: How does appendicitis manifest itself?
Everyone has probably experienced abdominal pain without knowing its exact origin. Even an inflamed appendix does not always send out signals that clearly indicate appendicitis.
Nevertheless, there are various signs that are typical of appendicitis:
- At the beginning: usually not so severe pain near the navel.
- After a few hours: The pain shifts to the right lower abdomen.
- Putting on the right leg is particularly painful.
- Upright posture and vibrations, e.g. when walking, cause additional pain.
- Shifting of the pain to the entire abdominal cavity. Any touching of the abdomen is very painful.
The appendix is not located in the same place in every person. Sometimes, for example during pregnancy, the position of the appendix can be significantly altered. It is therefore quite possible that you will experience appendicitis pain that does not correspond to the typical characteristics of appendicitis. For example, the entire abdomen may hurt, or the pain may not radiate to the right side of the lower abdomen, but to its left side.
Diagnosis: How can appendicitis be diagnosed?
If you are suspected of having an inflamed appendix, your doctor will palpate your abdomen. There are certain points that trigger severe pain in appendicitis as soon as they are pressed. If this is the case, you will reflexively tense your abdominal wall – and the diagnosis of appendicitis can be made with great certainty clinically, i.e. by examination. But it’s not always that simple.
Even if there are apparently clear signs of appendicitis, it cannot be ruled out that there is another illness behind the pain you are experiencing. For example, there may be a protrusion of the small intestine, a so-called Meckel’s diverticulum, which can be mistaken for appendicitis. In women, inflammation of the ovaries can also cause similar symptoms.
Examination methods appendicitis
Further examination methods can be used to confirm the diagnosis:
The most accurate appendix diagnosis can be made with a laparoscopy and histologic diagnosis by the pathologists who examine the appendix after removal. If appendicitis is present, it usually shows up during the laparoscopy in the form of a distended, reddened appendix, or in the form of a hole in the appendix with stool or pus discharge.
Clinical picture: How does appendicitis progress?
Depending on who is affected, the course of appendicitis can vary:
- In many cases, older people do not experience sudden, cramp-like pain, but rather a gradual progression of appendicitis.
- Children often feel severe pain that extends over the entire abdomen. Nausea and vomiting occur more frequently in them than in adults.
- Pregnant women often feel appendicitis pain in atypical places because their enlarged uterus pushes the bowel away towards the head. In some cases, appendicitis can also make itself felt in the middle or upper part of the abdomen. And even on the back.
Otherwise, appendicitis in women is no different from appendicitis in men.
If you are concerned that your appendix may have become inflamed, you should not hesitate for a moment, but seek medical advice quickly. This is because appendicitis that is treated too late can be life-threatening. In the worst case scenario, the blocked outlet of the appendix creates pressure that causes the intestine to rupture. During this so-called perforation, those affected initially feel particularly severe pain – because at this moment, feces, bacteria and other intestinal contents flow into the abdominal cavity, causing peritoneal irritation and severe pain.
Treatment: How is appendicitis treated?
Hardly any other operation has been part of the surgical repertoire in medicine for as long as appendectomy – in which the appendix is removed at its base at the coecum, the beginning of the large intestine. The removal of an inflamed appendix, known as an appendectomy, is carried out without any problems in the vast majority of cases. As a patient, you can normally leave hospital after an appendectomy after just a few days, especially if the appendix has not yet perforated.
In addition to conventional “open” surgery, in which the abdomen is opened via a larger incision, minimally invasive (less invasive) laparoscopic surgery is now predominantly used. In this method, also known colloquially as “keyhole surgery”, small incisions are made through the abdominal wall. The surgeon looks into the abdomen through one of these openings, just below the navel, using a small camera. The surgical instruments are then inserted through two further openings located slightly lower down, and the vessel supplying the appendix and the appendix are separated at their base and pulled out in a retrieval bag.
One alternative to surgery that is occasionally discussed in medicine is the so-called conservative treatment of appendicitis. The aim is to combat appendicitis by administering antibiotics. Studies have shown that this is possible in some cases. However, treatment with medication cannot rule out the possibility that the appendicitis will heal safely or that the appendix will become inflamed again at some point. Surgical removal is therefore currently preferred – in line with the motto “better safe than sorry”.
Details of the treatments