Conditions
Appendicitis
Appendicitis is inflammation of the appendix, usually from a blockage at its opening. It is one of the more common reasons for urgent abdominal surgery, and delay is the main thing that makes it worse.
What goes wrong
The appendix is a narrow tube attached to the beginning of the large intestine. When its opening is blocked, pressure rises behind the blockage and bacteria multiply.
The wall becomes inflamed and its blood supply is compromised. Left untreated that can progress to perforation. The progression is measured in hours to a day or two, not weeks.
How the pain typically behaves
The classic pattern begins with vague discomfort around the navel that settles into the lower right abdomen over several hours and becomes sharper.
Loss of appetite usually comes first, and nausea follows the pain. Presentations vary, particularly in children, older adults, and pregnancy, so an atypical pattern does not rule it out.
Diagnosis in the acute setting
Focal tenderness in the lower right abdomen with pain on release is a strong signal, and blood work commonly shows an elevated white count, with urinalysis and pregnancy testing to consider other causes. CT is the usual imaging in adults, with ultrasound first in children and pregnancy. Diagnosis is generally made in an emergency department, because the timeline demands it.
How it is treated
Removal of the appendix is the standard treatment and is performed laparoscopically in most cases, through several small incisions. Antibiotics are given around the operation.
Antibiotics alone are used in selected uncomplicated cases, in consultation with a surgeon, though recurrence rates are meaningful and not everyone is suitable. When an abscess has already formed, treatment is sometimes staged: drainage and antibiotics first, with removal considered later.
Go to an emergency department, not an office
Suspected appendicitis is not an appointment. Persistent lower right abdominal pain, especially with fever, vomiting, or pain that worsens with movement, should be evaluated in an emergency department immediately.
This page exists for understanding after the fact, or for follow up care and questions once the acute episode has been managed.
This page is educational information, not medical advice. What is right for you is decided in consultation, after a review of your history, your symptoms, and your testing.
Common questions
- Can appendicitis resolve on its own?
- Occasionally mild inflammation settles, but relying on that is dangerous. Progression to perforation is the risk, and it is not predictable in advance.
- Is antibiotic treatment without an operation a real option?
- Antibiotics first is an accepted option for uncomplicated appendicitis, but it is not definitive. In the largest United States trial, about forty percent of patients treated with antibiotics had an appendectomy within one year and roughly half by three to four years. An appendicolith raises that risk further.
- Does the appendix serve a purpose?
- It appears to have a role in immune tissue and gut bacteria, but people live normally without it and no replacement is needed.
- How long is recovery?
- After an uncomplicated laparoscopic removal, return to routine activity is individualized. A complicated case with infection takes longer.
Related conditions and services
Next step
For an active episode, go to an emergency department. For follow up questions, reach us here.
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