Acute Appendicitis: When Is It an Emergency?

Acute appendicitis is a rapidly progressing inflammation of a small part of the large intestine called the appendix. It is the most common reason for emergency abdominal surgery. Acute appendicitis is a common and serious condition that requires immediate surgery for treatment. Prompt removal of the appendix can prevent life threatening complications. These include ruptured appendix and peritonitis, which is infection of the membrane that lines your inner abdomen.

This article will provide an overview of acute appendicitis, including symptoms that indicate an emergency. It will also discuss causes, complications, and treatments for acute appendicitis.

The appendix is a small, pinky finger-shaped structure located in the lower right quadrant of the abdomen, near the area where the small intestine joins the large intestine. The exact function of the appendix is not known.

In acute appendicitis, the appendix swells and begins to fill with rapidly growing bacteria and pus. This results in symptoms including pain in the right lower area of the abdomen and fever. However, not all people with acute appendicitis will experience typical symptoms.

Acute appendicitis can occur at any age. However, it is most common in children and teenagers ages 10–19.

One classic symptom of acute appendicitis includes pain in the right lower abdomen, where the appendix is located, that gets progressively sharp and more intense.

Pain increases when pressure is on the area, which is called McBurney’s point. When a healthcare professional puts some pressure on the area and releases that pressure, the area becomes even more painful and tender. This is one exam they use to diagnose acute appendicitis.

In early acute appendicitis, the abdominal pain may occur around the navel or belly button area, then move to McBurney’s point as acute appendicitis progresses.

The symptoms of acute appendicitis can vary, and not all people with acute appendicitis will experience the typical symptoms of abdominal pain.

Symptoms of acute appendicitis can include:

• abdominal pain, swelling, distension, or bloating
• chills
• constipation
• diarrhea
• fever
• loss of appetite
• nausea
• episodes of vomiting
• discomfort urinating or blood in urine

If you or your child experience any of these symptoms, contact your primary care physician or pediatrician for an evaluation as soon as possible. Delayed diagnosis of acute appendicitis increases the likelihood of a rupture or other serious complication.

Acute appendicitis can lead to life threatening complications, such as ruptured appendix, peritonitis, and shock.

Without prompt treatment, acute appendicitis can lead to life threatening complications. These include the following.

• Rupture: If a hole develops in the appendix, it can lead to sepsis, which is a dangerous systemic immune reaction. Perforation occurs in up to one-third of people who develop acute appendicitis.
• Peritonitis: A rupture can cause an infection of the lining in the abdomen called peritonitis. When this occurs, doctors refer to it as complicated appendicitis. Complicated appendicitis is more common in biological males and older adults.
• Abscess: A ruptured appendix can also lead to an abdominal abscess, which is a contained pocket of pus that results from a bacterial infection.

In very rare cases, inflammation associated with acute appendicitis can cause blockage of the small intestine.

Getting prompt care for symptoms of acute appendicitis can reduce your risk of complications and allow for faster, more effective treatment.

Early appendectomy is the most effective treatment for acute appendicitis. Removing the appendix before it ruptures helps prevent serious complications such as peritonitis or abscess.

Doctors often use a combination of medications and surgery to treat acute appendicitis.

• antibiotics, either oral or IV, to clear any infections
• pain relievers, including acetaminophen, nonsteroidal anti-inflammatory drugs, or opioids

Doctors typically choose from two types of surgery to remove an inflamed appendix.

• Laparoscopic appendectomy: This procedure is a minimally invasive surgery that uses small incisions in the abdomen and camera-guided tools to remove the appendix.
• Open appendectomy: This procedure is more invasive surgery to remove the appendix and clean out the abdominal cavity. Doctors typically need to perform an open appendectomy if the appendix ruptures before removal.

Depending on the severity of the appendicitis and the type of surgery doctors perform, many people go home from the hospital the same day. Others may require hospitalization for 2–3 days. Full recovery from appendectomy can take several weeks.

Acute appendicitis can occur when a piece of food, stool, or another object becomes trapped in the appendix. This can cause irritation, inflammation, and the rapid growth of bacteria, leading to infection.

Acute appendicitis can also happen after a gastrointestinal infection. Rarely, a tumor may cause acute appendicitis. Sometimes the cause of acute appendicitis is not known.

In rare cases, doctors may diagnose someone with chronic appendicitis. This occurs when someone has recurring instances of lower right abdominal pain, but the appendix does not show signs of serious inflammation.

While researchers have a good understanding of how acute appendicitis develops, the causes of chronic appendicitis are less clear.

These are some other questions people often ask about acute appendicitis. The answers have been reviewed by Darragh O’Carroll, MD.

Acute appendicitis symptoms typically progress quickly, within 24 hours of starting. The risk of rupture is low at the beginning of acute appendicitis, but goes up steadily and becomes high after 48 hours or more.

Pain is a primary symptom of acute appendicitis. Abdominal pain that becomes more severe and does not go away can be a symptom of appendicitis. Pressing on the area is typically painful, then releasing the area causes worse pain. Contact your primary care physician or your child’s pediatrician for any early symptoms of acute appendicitis.

The overall incidence of foods causing acute appendicitis is very low. However, in certain cases, researchers identified foods as a cause. These included seeds from fruits and vegetables including oranges, grapes, figs, dates, and melon, as well as foods such as oats, barley, and cacao.

Acute appendicitis is inflammation of the appendix, which is a small pouch near the area where the small intestine joins the large intestine. Due to the risk of the appendix rupturing, doctors often need to perform emergency removal of the appendix.

Acute appendicitis is the most common reason for emergency abdominal surgery. The condition can occur at any age, but it is most common from the ages of 10–19.

Contact your primary care doctor or pediatrician right away for any symptoms of appendicitis to lower the risk of serious or life threatening complications.