Appendicitis and removal of the appendix

The appendix is a small pouch joined to the large intestine at a point called the caecum. Appendicitis is inflammation and infection of the appendix. This information from Great Ormond Street Hospital (GOSH) explains the causes, symptoms and treatment of appendicitis and where to get help.The appendix is a small pouch joined to the large intestine at a point called the caecum. This is where the small intestine joins the large intestine. The appendix is thought to play a part in immunity for the first few years of life but then does not appear to have a purpose after this.

Appendicitis is inflammation and infection of the appendix, usually after it has become blocked by mucus or faeces (poo). This blockage irritates the appendix, which swells and fills up with pus. If it is not treated at this point, the appendix can rupture (burst) or perforate (develop a hole) which lets the pus leak into the abdominal cavity. This can cause a severe infection called peritonitis.

Doctors are not sure what causes appendicitis, but it seems linked to the appendix becoming blocked by mucus or faeces. It seems that eating a diet low in fibre can increase the risk of blockage. Appendicitis is quite a common reason for abdominal surgery, particularly in older children and teenagers.

The main sign of appendicitis is pain, which usually starts in the middle of the abdomen but moves towards the lower right side over the appendix. The pain usually gets worse over a period of hours and moving or coughing makes it worse. Accompanying the pain are feelings of sickness and a high temperature.

Some people develop constipation or diarrhoea or pass more urine than usual. Occasionally, the symptoms are ‘atypical’, that is, they do not follow the pattern described above. The pain may develop more slowly over a period of days or weeks, affecting different areas of the abdomen.

Although the symptoms of appendicitis usually develop as described above, they can also indicate other abdominal conditions apart from appendicitis. The doctor will usually ask for a description of the symptoms, how they started and how long they have lasted. They will feel the abdomen to identify the location of the pain and feel for any swelling. Usually, if appendicitis is suspected, an urgent admission to hospital will be arranged.

Once in hospital, some tests may be requested, such as blood and urine tests and imaging, such as ultrasound or CT scans. These will be used to identify any inflammation or infection and its location.

Appendicitis may be treated in two ways. Sometimes antibiotics will be the primary treatment especially if a large amount of the bowel sticks together to form a lump. Often an operation is also needed. The appendix is not thought to have any purpose, so removing it does not cause long term problems and is safer than risking it rupturing and leading to peritonitis. The operation to remove the appendix is usually carried out using keyhole (laparoscopic) surgery with a general anaesthetic, although the surgeon may use traditional open surgery if the appendix has ruptured.

During the operation, the surgeon cuts off the appendix where it joins the caecum and closes the hole with stitches so that intestinal contents cannot leak into the abdomen. The operation usually lasts about an hour. After the operation, your child will have an intravenous infusion of fluids until they feel like eating and drinking again. They will also have regular pain relief usually intravenously and then by mouth as well as antibiotics to prevent infection. They will be able to return home once they have recovered from the operation and anaesthetic and return to school around a week later.

Removal of the appendix usually has no long term effects and recovery does not take long. If the appendix had ruptured, recovery may take a little longer. Occasionally, the operation wound can become infected requiring further treatment although this is very rare with laparoscopic surgery. One of the risks following appendicitis, and also the operation to remove the appendix, is the development of abdominal adhesions. These are bands of tissue that form inside  the abdomen which ‘stick’ organs and tissues together. Generally abdominal adhesions do not cause any problems but occasionally they can lead to obstruction and pain.