Appendicitis

Appendicitis is an inflammation of the appendix that is often caused by an obstruction, but it may be caused by an infection. The appendix is a small sac-like appendage of the large intestine that hangs down on the lower right side of the abdominal cavity. Appendicitis is frequently misdiagnosed, since it mimics other diseases. If untreated, an inflamed appendix can rupture, causing infection of the peritoneal cavity (the lining surrounding the abdominal organs) and even death. Between 5 and 10% of the population develop appendicitis, usually in their teens and twenties.

Signs and Symptoms

Appendicitis is accompanied by the following signs and symptoms:

• Pain on the right side of the abdomen, usually beginning near the navel and moving down and to the right. The pain worsens when moving, taking deep breaths, coughing, sneezing, or being touched in this area.
• Loss of appetite
• Nausea
• Vomiting
• Change in bowel movements, including diarrhea or inability to have a bowel movement or to pass gas
• Low fever that begins after other symptoms
• Urinating frequently, or difficult or painful urination
• Bloating

What Causes It?

Appendicitis usually occurs following an infection in the digestive tract, or when the tube connecting the large intestine and appendix is blocked by trapped feces. The resulting inflammation can result in infection or rupture of the appendix.

Who's Most At Risk?

The following factors can put you at higher risk for developing appendicitis:

• Family history
• Children 2 years of age or younger and people 70 years of age or older are at higher risk for a ruptured appendix

What to Expect at Your Provider's Office

Because of the risk of rupture, appendicitis is considered an emergency. If you are experiencing symptoms associated with appendicitis, you should seek immediate medical attention. The doctor will ask about your symptoms and your medical history, conduct a physical exam to check for abdominal tenderness, and may order blood tests and urine tests. Some providers use ultrasound to check whether the appendix is inflamed (and to rule out ovarian abnormalities or ectopic pregnancy in women). A computed tomography (CT) scan may also be performed.

Treatment Options

Prevention
Eating a diet that includes green vegetables may decrease the likelihood of developing appendicitis.

Treatment Plan
Appendicitis is most often treated with a combination of surgery and antibiotics. In addition to antibiotics, you will receive intravenous fluids and, if nauseated, medication to control vomiting. If you have symptoms of appendicitis, you will be evaluated for surgery. When the diagnosis is not clear from tests such as an ultrasound or CT scan, exploratory surgery is performed. If appendicitis is confirmed, either from the tests or the exploratory surgery, the appendix is removed in a procedure called an appendectomy.

Drug Therapies
Your provider may prescribe the following medications.

• Antibiotics
• Medications taken to ease nausea

Surgical and Other Procedures

An appendectomy is the surgical removal of the appendix through an incision in your abdomen that can be several inches long. A laparoscopic appendectomy involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. The surgeon then removes the appendix through one of the small incisions. The advantage of laparoscopic appendectomy is that recovery is usually faster than with traditional surgery. However, not everyone is a candidate for the laparoscopic procedure.

Complementary and Alternative Therapies

Acute appendicitis is a medical emergency, so you should seek conventional treatment immediately. Some studies show that certain nutritional choices may help to prevent appendicitis or may boost your immune system. Also, Traditional Chinese Medicine (TCM) using herbs and/or acupuncture has been used to treat appendicitis; see details in the sections on Herbs and Acupuncture.

On the other hand, certain folk remedies may worsen appendicitis, may cause symptoms similar to appendicitis, or may bring about acute appendicitis. For instance, traditional Mexican American remedies used to treat stomach upset include elemental mercury or lead salts. These may cause abdominal pain, nausea, vomiting, and malaise, symptoms that resemble appendicitis.

Nutrition
In England and Wales, a study was performed to review whether low intake of fiber and high intake of sugar and meat may influence the development of acute appendicitis. The study evaluated the dietary habits of 49,690 patients diagnosed with acute appendicitis. Although no specific correlation was found with sugar or meat, the analysis did suggest that the more fresh and frozen green vegetables and fresh and processed tomatoes people ate, the less likely they were to develop appendicitis. The researchers concluded that eating green vegetables—particularly cabbages, cauliflowers, peas, beans, and Brussels sprouts—and possibly tomatoes may protect against appendicitis.

Another study reviewed the link between abdominal microbes and the immune system in children with acute appendicitis who had or had not been breastfed. Children (mean age 7 to 8 years) with acute appendicitis were less likely to have been breastfed over a long period of time compared to a group of randomly selected children from the same geographic area. The authors suggest that human milk may boost the immune system, and it may make infections and inflammation less severe.

Herbs
Traditional Chinese herbal therapies may help treat appendicitis. There is not yet enough scientific research on Chinese or Western herbs to be sure, but there are some case reports from a TCM perspective. In a report of 425 patients with acute appendicitis treated with Chinese herbal preparations, either with or without antibiotics, the majority of patients did extremely well and did not require surgery. Of the 425 cases, 93% were cured with TCM alone, 4% with TCM and antibiotics together, and 3% with surgery after medicine failed. Only thirty patients had acute relapse of appendicitis shortly after recovery. Given that appendicitis sometimes resolves but then recurs, a subset of the people who had not had surgery were followed for 1 year; 85% of them experienced complete recovery without recurrence during that period.

Some examples of herbal therapies used in TCM include: detoxifying and fever-reducing herbs (Flos lonicerae, Fructus forsythiae, Herba taraxaci, Patrinia scabioseafolia, Gypsum fibrosum), circulation-enhancing herbs (Semen persicae, Radix paeoniae rubra, Squama manitis, Spina gleditsiae), and laxatives (Rhizoma rhei, Mirabilitum depuratum).

Homeopathy
Belladonna and Bryonia are classic homeopathic remedies often used for an inflamed appendix. Using the appropriate homeopathic remedy along with conventional Western medicine may relieve your symptoms and help clear up appendicitis more quickly. However, no scientific literature supports the use of homeopathy for appendicitis. An experienced homeopath would consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.

Prognosis/Possible Complications
In cases without rupture, the risk of death is very low. In cases where the appendix ruptures, the mortality rate is higher, and is especially high among the elderly (15%). Complications may include recurring appendicitis, inflammation of the abdominal lining, abscess (pus-filled inflamed area), sepsis (poisoning caused by the presence of infectious bacteria in the blood), obstruction of a fallopian tube, infertility, and wound infection. Appendicitis only occurs in about 1 in 1000 pregnancies.

Following Up
If you have surgery, you will need to see your provider 2 weeks after the operation, and again at 6 weeks.

References

Acute Appendicitis. Ada Health. Accessed at https://ada.com/ on November 18, 2018.

Analgesics. NMIHI. Accessed at http://drugs.nmihi.com/analgesics.htm on November 18, 2018.

Appendicitis. NMIHI. Accessed at http://www.nmihi.com/a/appendicitis.htm on November 18, 2018.

Appendicitis. MedlinePlus. Accessed at https://medlineplus.gov/ on November 18, 2018.

Appendicitis. Symptoms and causes. MFMER. Accessed at https://www.mayoclinic.org/ on November 18, 2018.

Barker DJ, Morris J, Nelson M. Vegetable consumption and acute appendicitis in 59 areas in England and Wales. Br Med J (Clin Res Ed). 1986;292(6525):927-930.

Baclofen. NMIHI. Accessed at http://www.nmihi.com/b/baclofen.html

Behrman RE, ed. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Co-trimoxazole. NMIHI. Accessed at http://www.nmihi.com/t/co-trimoxazole.html

Dambro MR. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: W.B. Saunders Co; 1998.

Fan YK, Zhang CC. 20 years' acupuncture in 461 acute appendicitis cases. Chin Med J (Engl). 1983;96(7):491-494.

Garcia Peña BM, Mandl KD, Kraus SJ, et al. Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA. 1999;282(11):1041-1046.

How is appendicitis diagnosed? American Academy of Family Physicians Accessed at https://familydoctor.org/ on November 18, 2018.

Longmire WP Jr. Invited commentary. World J Surg. 1979;3(1):130-132.

McKinney PE. Elemental mercury in the appendix: an unusual complication of a Mexican-American folk remedy. J Toxicol Clin Toxicol. 1999;37(1):103-107.

No author listed Combined traditional Chinese and Western medicine in acute appendicitis. Chin Med J (Engl). 1977;3(4):266-269.

No author listed. Treatment of acute appendicitis in children with combined traditional Chinese and Western medicine. Chin Med J (Engl). 1977;3(6):373-378.

Pisacane A, de Luca U, Impagliazzo N, Russo M, De Caprio C, Caracciolo G. Breast feeding and acute appendicitis. BMJ. 1995;310(6983):836-837.

Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338(3):141-146.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Sabiston DC, Lyerly HK, eds. Textbook of Surgery. 15th ed. Philadelphia, Pa: W.B. Saunders Co; 1998.

Wu HC. Treatment of acute abdominal diseases by combined traditional Chinese and Western medicine. World J Surg. 1979;3(1):91-94.

Zheng XL, Chen C, Wu XZ. Acupuncture therapy in acute abdomen. Am J Chin Med. 1985;13(1-4):127-131.