Appendix death: Appendicitis – Digestive Disorders – Merck Manuals Consumer Version
Appendicitis – Digestive Disorders – Merck Manuals Consumer Version
By
Parswa Ansari
, MD, Hofstra Northwell-Lenox Hill Hospital, New York
Reviewed/Revised Apr 2023
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Topic Resources
Appendicitis is inflammation and infection of the appendix.
Often a blockage inside the appendix causes the appendix to become inflamed and infected.
Abdominal pain, nausea, and fever are common.
Exploratory surgery or an imaging test, such as computed tomography or ultrasonography, is done.
Treatment involves surgery to remove the appendix and antibiotics to treat the infection.
(See also Acute Abdominal Pain Overview of Gastrointestinal Emergencies Certain gastrointestinal disorders can be life threatening and require emergency treatment. For many people, emergency treatment involves surgery. Abdominal pain, often severe, usually accompanies… read more .)
The appendix is a small finger-shaped tube projecting from the large intestine near the point where it joins the small intestine. The appendix may have some immune function, but it is not an essential organ.
The Digestive System
Appendicitis is the most common cause of sudden, severe abdominal pain and abdominal surgery in the United States. Over 5% of the population develops appendicitis at some point. Appendicitis most commonly occurs during adolescence and in the 20s but may occur at any age.
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The cause of appendicitis is not fully understood. However, in most cases, a blockage inside the appendix probably starts a process. The blockage may be from a small, hard piece of stool (fecalith), a foreign body, tumor, or, rarely, even worms. As a result of the blockage, the appendix becomes inflamed and infected. If inflammation continues without treatment, the appendix can rupture.
A ruptured appendix may cause a pus-filled pocket of infection (abscess Abdominal Abscesses An abscess is a pocket of pus, usually caused by a bacterial infection. Most people have constant abdominal pain and a fever. Computed tomography or another imaging test can distinguish an abscess… read more ) to form. As a result, peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem.
The pain may be the only sign of the need for surgery… read more (inflammation and usually infection of the abdominal cavity, which may result in a life-threatening infection) may develop. In a woman, the ovaries and fallopian tubes may become infected, and the resulting scarring may block the fallopian tubes and cause infertility. A ruptured appendix also may allow bacteria to infect the bloodstream—a life-threatening condition called sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure … read more .
Pain begins in the upper abdomen or around the navel, then nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain shifts to the right lower portion of the abdomen. Although these symptoms are the most traditionally described, fewer than 50% of people with appendicitis have them.
When a doctor presses on the right lower portion of the abdomen, it is tender, and when the pressure is released, the pain may increase sharply (rebound tenderness).
A fever of 100° to 101° F (37.7° to 38.3° C) is common. Moving and coughing increase the pain.
In many people, particularly infants and children, the pain may be widespread rather than confined to the right lower portion of the abdomen. In older people and in pregnant women, the pain may be less severe, and the area is less tender.
If the appendix ruptures, pain may lessen for several hours. Then, peritonitis occurs, and pain and fever may become severe. Worsening infection can lead to shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low… read more .
Did You Know…
A doctor may suspect appendicitis after reviewing the person’s symptoms and examining the abdomen.
Typically, surgery is done immediately if the doctor strongly suspects appendicitis.
If the diagnosis of appendicitis is not clear, doctors usually do an imaging test such as computed tomography Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT) and magnetic resonance imaging (MRI) scans are good tests for assessing the size and location of abdominal organs. Additionally, cancerous (malignant) or noncancerous… read more (CT) or ultrasonography Ultrasound Scanning (Ultrasonography) of the Abdomen Ultrasound scanning uses sound waves to produce pictures of internal organs (see also Ultrasonography). An ultrasound scan can show the size and shape of many organs, such as the liver and pancreas… read more . Ultrasonography is particularly useful in children, in whom it is important to limit radiation exposure to reduce the risk of future cancers.
Surgeons can also do laparoscopy Laparoscopy Laparoscopy is an examination of the abdominal cavity using a fiberoptic instrument inserted through the abdominal wall.
This is a surgical procedure done in an operating room. People are given… read more to explore the abdominal cavity and help determine the diagnosis.
A blood test often shows a moderate increase in the white blood cell count because of the infection, but there is no definitive blood test for appendicitis.
Surgery is the main treatment of appendicitis. Delaying surgery until the cause of the abdominal pain is certain can be fatal: An infected appendix can rupture less than 36 hours after symptoms begin.
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If appendicitis is found, fluids and antibiotics are given by vein and the appendix is removed (appendectomy). If the doctor does an operation and appendicitis is not found, the appendix is usually removed anyway to prevent any future risk of appendicitis.
There has been recent interest in treating appendicitis only with antibiotics, so that surgery can be postponed or avoided. Although this treatment may be successful in some people, many of them eventually need surgery.
Surgical removal of the appendix is still considered the most effective and thus usually the recommended treatment for appendicitis.
With an early operation, the chance of death from appendicitis is very low. The person can usually leave the hospital in 1 to 3 days, and recovery is normally quick and complete. However, older people often take longer to recover.
Without surgery or antibiotics (as might occur in a person in a remote location without access to modern medical care), more than 50% of people with appendicitis die.
The prognosis is worse for people who have a ruptured appendix, an abscess, or peritonitis.
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What Is a Ruptured Appendix? Causes, Treatment, and Complications
Your appendix can become inflamed and filled with pus (a fluid made up of dead cells and bacteria) if an abdominal infection spreads to the organ, or if an obstruction (stool) blocks the area inside of your appendix called the appendiceal lumen, or appendix lumen. (1,2)
This condition, known as appendicitis, is marked by sharp pain that begins near the navel and then localizes over time to the lower right abdomen, where the appendix is located. The pain gets worse with movement, deep breaths, coughing, and sneezing.
Other appendicitis symptoms include:
- Nausea
- Vomiting
- Constipation
- Diarrhea
- Inability to pass gas
- Loss of appetite
- Fever
- Chills
- Abdominal swelling
The standard treatment for appendicitis is an appendectomy, a surgical procedure to remove the appendix.
Complications of a Ruptured Appendix
Sepsis Symptoms and Diagnosis
But if doctors don’t remove the appendix quickly — usually within 24 to 72 hours after symptoms begin — the organ may rupture, or burst. (3) The result is a “perforated appendix.” It hasn’t popped like a balloon, but rather the appendix develops a small tear, which allows its contents to leak out into the rest of the abdomen and potentially cause other complications such as peritonitis, a severe inflammation of the intestinal lining, or a serious blood infection called septicemia.
Perforation is found in about 13 to 20 percent of patients who have symptoms of appendicitis. (4) Children younger than 5 have a higher risk of perforation because they may not be able to describe and talk about their symptoms as clearly as older children and adults. (3)
The Symptoms and Dangers of a Ruptured Appendix
More on Symptoms of a Ruptured Appendix
10 Essential Facts About Fevers
When your appendix ruptures, you may start to feel better as the appendix pain you originally had subsides.
But this generally doesn’t last long, because a perforated appendix can quickly lead to other health issues.
Pus-filled abscesses may develop around your appendix. Scar tissue and other abdominal structures will “wall off” the abscessed appendix and the seepage, preventing the infection from spreading. A ruptured appendix can be a serious emergency and the patient should seek medical attention immediately.
If you have an abscessed appendix, you may experience symptoms similar to appendicitis, including: (5)
- Pain in your lower right abdomen
- Diarrhea
- Lack of appetite
- Nausea
- Vomiting
- Fever
- Chills
You may also experience other symptoms not typically associated with appendicitis, such as weakness, chills, high fever, and a feeling of rectal fullness.
Additionally, the infected contents that have seeped out of your appendix may cause peritonitis, which is an infection of the peritoneum, the silk-like membrane that lines the abdominal cavity.
(6)
The inflammation and pain can spread throughout your abdomen, and become worse with any kind of movement. Other symptoms of peritonitis can include:
- Decreased appetite
- Fever
- Nausea
- Extreme thirst
- Vomiting
- Chills
- Confusion
- Rapid breathing
- Urinating less than normal or not at all
Treatment Options for a Ruptured Appendix
In most cases of peritonitis, a surgeon will remove your appendix immediately and clean the inside of your abdomen to prevent infection.
Doctors sometimes try to treat the abscess or peritonitis with antibiotics and drainage before conducting an appendectomy. When an abscess is present, there’s a higher complication rate with surgery, so your doctor may try to resolve the abscess first if possible. (3)
Treatments usually involve draining any pus from the abdomen and fighting the infection with strong antibiotics for several weeks. (7) But some research suggests that immediately removing the ruptured appendix results in quicker recovery and fewer postoperative complications, particularly in children.
A research review published in the Cochrane Database compared early versus delayed appendectomy in cases of complicated appendicitis. (8) The review authors note that it was unclear whether early appendectomy prevents complications when compared with delayed appendectomy in these kinds of patients. They concluded that more and better-quality data — concerning length of hospital stay and health-related quality of life outcomes — is needed to determine what benefits or harms there might be in early versus delayed appendectomy.
A ruptured appendix can actually lead to death in some cases. If left untreated, peritonitis can quickly spread, resulting in septicemia, or bacteria in the blood. Your body releases chemicals into the bloodstream to fight this infection, triggering an inflammatory response throughout the body called sepsis. A cascade of reactions will follow, which can eventually lead to septic shock, which may cause severely low blood pressure and organ failure and death.
Additional reporting by Deborah Shapiro.
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Why appendicitis is dangerous and how to deal with it
In the right iliac region of a person there is an appendix – a worm-like appendage of the caecum up to 1 cm thick and up to 23 cm long (usually 7-9 cm).
It performs a protective function of the body due to the accumulation of lymphoid tissue in it. In addition, it plays an important role in maintaining the intestinal microflora.
Inflammation of this process is called appendicitis. Until now, the most common method of treating appendicitis is the removal of the appendix, however, in recent decades, the prevalence of antibiotic therapy has gradually increased.
One of the first known operations to remove the appendix was performed in 1735 in London by the royal surgeon Clodis Amiand. He operated on an 11-year-old child who soon recovered. By 1839, the clinical picture of acute appendicitis was described in detail, it was also established that it is an independent disease, and not a complication of inflammation of the caecum, as previously thought.
The term “appendicitis” appeared in 1886, it was introduced by the American physiologist Reginald Gerber Fitz. Then it was found that the optimal method of treatment is the removal of the appendix.
In Russia, the first operation to remove the appendix was performed in 1890 year. However, they began to be carried out regularly only after the IX Congress of Russian Surgeons in 1909 – before that, doctors adhered to a wait-and-see approach, resorting to surgical intervention only in extreme cases.
The first doctor to operate on himself was the American surgeon Evan Kane in 1921. He successfully removed his own appendix as part of a study of patient tolerance to local anesthesia.
And in 1961, the Soviet surgeon Leonid Rogozov, a member of the 6th Soviet Antarctic Expedition, operated on himself.
During the expedition, he discovered a clinical picture of acute appendicitis, conservative treatment – rest, hunger, local cold and antibiotics – did not help. It was impossible to get to the hospital.
With the help of other members of the expedition, who gave instruments and monitored Rogozov’s condition, the surgeon operated on himself for almost two hours.
Because of the weakness that appeared during the operation, he now and then had to pause. But he successfully completed the operation, and a week later he removed the stitches.
“At the most difficult stage of the appendix removal, I lost heart: my heart stopped and noticeably slowed down, and my hands became like rubber,” Rogozov recalled. Well, I thought, this will end badly. But all that remained was to actually remove the appendix! But then I realized that I was actually already saved!”
Appendicitis manifests itself at any age, but mostly at 15-35 years. Women experience it 2-3 times more often than men, but men are more likely to experience complications. The removal of the appendix accounts for up to 80% of all emergency operations. The incidence of acute appendicitis is 4-5 cases per 1000 people per year.
The main symptoms of appendicitis are pain in the right side, fever, nausea and vomiting. On palpation of the right iliac region, appendicitis is characterized by increased pain with a sharp decrease in pressure.
In clinical practice, there are two forms of appendicitis – acute and chronic. When acute appendicitis occurs, urgent treatment is necessary, the main cause of death is a delay of more than two days between the onset of symptoms and the start of treatment.
Delay threatens the development of complications, for example, the formation of appendicular infiltrate – an accumulation of densely fused altered tissues. In this case, it is no longer possible to remove the appendix – it turns out to be inseparable from the surrounding tissues. The infiltrate can resolve on its own, which most often happens, or lead to suppuration with the formation of an abscess.
Another common complication is diffuse purulent peritonitis, inflammation of the peritoneum, complicated by the appearance of purulent foci.
Peritonitis directly threatens the patient’s life and in this case, an early operation is simply necessary.
Chronic appendicitis is rare. It occurs after acute appendicitis and is characterized by atrophic changes in the tissues of the appendix.
There are many theories for the development of acute appendicitis. According to the mechanical theory, it occurs due to blockage of the lumen of the appendix, mainly by fecal stones. When the lumen is filled with mucous secretion, the diameter of the process increases several times. This compresses the vessels inside the appendix itself, which leads to acute inflammation and necrosis.
Another cause of inflammation of the appendix can be an infection – the causative agents of infectious diseases, penetrating into the mucous membrane of the organ, lead to the development of appendicitis. It is also assumed that appendicitis may occur due to vascular spasms and circulatory disorders in the intestinal tissues.
At risk are people who regularly suffer from constipation. It is also assumed that the incidence of acute appendicitis is associated with a low content of vegetable fiber in the diet.
In the past 20 years, research has shown that appendicitis can be successfully treated with antibiotics, and the number of surgeries performed in the US has halved.
However, analysis of almost half a million registered cases of appendicitis showed that those patients who were operated on the first or second day after going to the hospital died from possible complications 2.4 times less than those who were treated with non-surgical methods.
It turned out that older people were more likely to undergo conservative treatment, which further worried the researchers.
“U.S. surgeons choose older patients for non-surgical treatment because they may not be the best candidates for surgery,” explains study lead author Dr. Isaiah Turnbull. —
However, these patients are at increased risk of poor outcomes because if treatment fails, their body does not have the resources to fight the disease.”
However, antibiotic treatment of appendicitis is good suitable for children. An analysis of 404 cases of acute appendicitis in childhood showed that with an uncomplicated course of the disease, treatment with antibiotics is successful in 90% of cases.
However, if appendicolitis occurs (exit of a stone from the appendix into the abdominal cavity) or other complications, it is still recommended to resort to surgical treatment.
Appendicitis – symptoms, causes, signs, diagnosis and treatment in “SM-Clinic”
The surgeon deals with the treatment of this disease
- What is appendicitis?
- Appendicitis forms
- Manifestations of appendicitis
- Causes of inflammation of the appendix
- Diagnosis of appendicitis
- Treatment of appendicitis
- Prevention of appendicitis
- Rehabilitation after surgery
- Questions and Answers
- Doctors
Appendicitis forms
Inflammation of the appendix can be acute and chronic. Slow inflammation leads to destructive processes in the walls, the growth of granulation tissue, which is fraught with the formation of adhesions, the formation of cysts and other complications.
Manifestations of appendicitis
Typical manifestations of acute appendicitis in the early stages of development include symptoms of general intoxication and pain.
The patient suffers from nausea, weakness, subfebrile temperature, chills. As inflammation progresses, diarrhea may occur.
Pain syndrome expressed. First, the pain is localized at the top of the abdomen, then it goes to the umbilical region and the right side (in the iliac region). Unpleasant sensations are aggravated by coughing and laughing, weaken when the patient lies on his right side and pulls his legs to his stomach.
Acute appendicitis may have atypical symptoms. More often it is observed in children, people aged, pregnant women. If there is diarrhea, vomiting, fever and abdominal discomfort, you should always consult a doctor to establish the true diagnosis and start treatment in a timely manner.
In chronic appendicitis, which is a possible outcome of an untreated acute one, patients experience aching dull pains in the right side. They occur against the background of physical exertion, gradually weaken and disappear.
Causes of inflammation of the appendix
The main reason for the development of the disease is the penetration of pathogenic bacteria into the lumen of the process.
The risk of inflammation of the appendix increases for people who suffer from regular constipation, eat a lot of protein foods, and have chronic pathologies of the digestive tract. Intestinal infections play a role.
Get advice
If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.
To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:
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Diagnosis of appendicitis
The condition is considered acute, therefore, it requires a quick response from doctors.
The examination is carried out in the first 2 hours after the patient’s admission to the hospital. Suspicions of appendicitis arise after collecting complaints. On examination, the doctor determines the symptoms specific to the pathology. To exclude other diseases with similar clinical manifestations, carry out:
- complete blood count;
- blood chemistry;
- gynecological examination for women;
- Ultrasound of the abdominal organs.
In doubtful situations, patients are prescribed computed tomography of the abdominal organs, which can significantly reduce the number of “futile” (unreasonable) surgical interventions.
The most reliable way to diagnose appendicitis is considered to be a laparoscopic examination, during which doctors have the opportunity to visually assess the condition of the appendix and determine the need for its removal. If the diagnosis is confirmed, then the inflamed organ is removed through the instruments inserted into the abdominal cavity.
Expert opinion
Appendicitis is an acute condition that requires urgent medical attention. Delay in going to the hospital is fraught with peritonitis and even death of the patient (due to the development of diffuse peritonitis and / or sepsis).
Surgery to remove the appendix (appendectomy) is considered technically simple. Currently, surgery is usually performed laparoscopically, when instruments are inserted into the abdominal cavity through small (1-1.5 cm) incisions. This technique is the most gentle, avoids severe pain in the postoperative period and promotes rapid recovery. Within 1-2-3 days after the operation, the patient can be discharged home.
Gon Igor Alexandrovich,
surgeon, phlebologist, doctor of the highest category, Ph.D.
Treatment of appendicitis
In 99% of cases, the operation is emergency. Acute inflammation of the appendix requires its removal as early as possible. Operations are performed in an open way (the abdominal cavity is opened with a scalpel) or using laparoscopic equipment.
If the inflammatory process has violated the integrity of the process wall, and diffuse peritonitis has developed, a median laparotomy, removal of the process, a thorough examination of the abdominal cavity, sanitation, and drainage are performed. In the postoperative period, antibiotics and painkillers are prescribed.
In the chronic form of inflammation (rare), treatment with conservative methods (laxatives, antispasmodics, antibacterial drugs) is possible. The appendix is removed later, during a planned operation.
Prevention of appendicitis
To prevent inflammation of the appendix, you should adhere to the principles of a healthy diet, eat at least 400 g per day of vegetables and fruits. It is important to avoid prolonged constipation. Also, a timely and doctor-controlled treatment of intestinal infections is considered a preventive measure.
Rehabilitation after surgery
After laparoscopic operations, the patient is discharged on the 2-3rd day.
Full working capacity is restored in 3-4 weeks.
After removal of the appendix by an open method, the patient stays in the hospital for 7-10 days. On the 14-15th day, the sutures are removed. Ability to work is restored in 4-5 weeks. Up to 2 months, physical activity and heavy lifting are contraindicated.
Questions and answers
Treated by a surgeon in the gastroenterology department of the hospital.
Pain in the right groin is a classic manifestation of appendicitis. However, atypical forms of the disease are also possible, which occur with the peculiarities of the position of the organ, as well as in children, women and the elderly. In such cases, pain can be in the left inguinal region, in the region of the right hypochondrium and even the pubis. In the presence of pain in the abdomen of any localization, especially if diarrhea, vomiting and fever are also present, you should immediately consult a doctor.
The disease affects people of any age – both children and adults.
However, appendicitis is especially dangerous in babies under 2 years old, because. the child cannot tell where it hurts and what worries him. Children become restless and capricious, do not allow to touch the stomach, vomiting and diarrhea appear, the temperature rises. If a child has these symptoms, then you should immediately contact the clinic so that pediatric surgeons can establish the final diagnosis.
A.V. Alekberzade, E.M. Lipnitsky Acute appendicitis. Educational and methodical manual, Moscow, 2017
Clinical guidelines. Acute appendicitis in adults, 2015
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