Treatment for Appendicitis

If you have appendicitis, your appendix will need to be removed as soon as possible with a procedure called an appendicectomy or appendectomy. The appendix is a small organ in the lower right abdomen (belly). It’s part of the digestive system, but you can live without it. 

Appendicitis is the most common abdominal surgical emergency in the world. Internationally, it affects about 100 out of every 100,000 adults. In the United States, about five to nine out of every 100 people get appendicitis, requiring emergency surgery. 

This article reviews diagnosis, complications, treatment, and special considerations during pregnancy. It also covers what happens before, during, and after an appendectomy. 

How Is Appendicitis Diagnosed?

A healthcare provider will diagnose appendicitis based on your medical history, symptoms, physical exam, and diagnostic tests.

Your provider may ask you questions like:

• Where is the pain? 
• When did the pain start?
• What does it feel like?
• What makes it worse?
• Do you have your appendix?
• Could you be pregnant?

During the exam, a healthcare provider will gently apply pressure to your abdomen and observe your reaction when they apply pressure. With appendicitis, the pain is typically worse after they release the pressure. 

Acute vs. Chronic Appendicitis

Acute (sudden) appendicitis is characterized by an abrupt onset of abdominal pain and associated symptoms. 

Chronic appendicitis is less common. The pain is not as severe and lasts for about a week (or longer). Diagnosis can be more challenging because the signs are not as apparent during the physical examination. 

Testing to Diagnose Appendicitis

Diagnostic tests for abdominal pain help your provider determine the cause, possible complications, the situation's urgency, and treatment. These tests include:

• Urinalysis: A urine sample looks for urinary tract infections (UTIs), kidney stones, and some sexually transmitted infections (STIs)
• Pregnancy tests: A urine or blood test for those with a uterus
• Blood tests: A complete blood count (CBC), chemistry panel, and C-reactive protein help identify infection, dehydration, and inflammation.
• Imaging tests: An ultrasound, X-ray, computer tomography (CT), or magnetic resonance imaging (MRI) 

Complications of Appendicitis

Prompt treatment for appendicitis reduces the risk of rupture and the following complications. 

Abscess

An abscess is a pocket of pus or infection that forms around a burst appendix. When this occurs, the surgeon will drain it during an appendectomy.

Peritonitis

Peritonitis is when the infected contents of a burst appendix spread to the peritoneum (the layer of tissue in the abdomen). The surgeon will clean the abdominal area with sterile salt water (saline) during an appendectomy if this occurs.

How Is Appendicitis Treated?

An appendectomy, the surgery that removes the appendix, is the most common treatment. Providers often perform this quickly (within hours) to prevent appendix rupture and complications.

Is Appendicitis Treatable Without Surgery? 

In some cases, intravenous (IV) antibiotics may treat appendicitis, especially when it's caught early. In this case, surgery may not be necessary. Ongoing research aims to understand who might be a good candidate for this approach.

How Quickly Must Appendicitis Be Treated?

The appendix can rupture within 48–72 hours after symptoms of appendicitis begin. Treatment, including surgery, typically occurs within 12–24 hours.

Are There Home Remedies for Appendicitis?

There are no self-diagnostic tests or home remedies for appendicitis. It is a severe condition that requires immediate medical care.

How to Treat Appendicitis During Pregnancy

One in every 1,000 pregnant women has appendicitis during pregnancy, requiring immediate surgery. Early treatment is vital because if the appendix ruptures, the risk of losing the baby increases from 1.5–36%. 

Diagnoses can be challenging because appendicitis and pregnancy share similar symptoms. Pregnancy also presents concerns regarding diagnostic procedures and varying parameters (values). 

For those who live far away or have difficulty getting to the surgical center, healthcare providers typically give IV antibiotics to bridge the gap until surgery. 

What to Expect During an Appendectomy 

Your surgeon may recommend either a laparoscopic or open appendectomy for appendicitis treatment. An appendectomy is a surgical operation to remove your appendix.

Laparoscopic Appendectomy Procedure

Laparoscopy is a minimally invasive surgery using surgical tools and a laparoscope, a thin tube attached to a tiny camera.

During a laparoscopic appendectomy:

• The surgeon makes several small incisions (cuts).
• They place carbon dioxide gas in your belly to swell it up, allowing them to see inside it better.
• They insert the laparoscope into an incision, and the camera sends images to a monitor. 
• The surgeon uses the monitor to guide the surgical tools while removing the appendix through one of the incisions.
• When the surgery is complete, they remove the tools and close the incisions with stitches or surgical glue.

Open Appendectomy Procedure

An open appendectomy requires a larger incision and is more invasive than a laparoscopic appendectomy. During an open appendectomy:

• The surgeon makes a 2-to-4-inch incision on the right side of your abdomen.
• They locate and tie off the appendix with stitches before removing it.
• If the appendix has burst, they will wash out the abdomen with sterile saltwater (saline).
• If there was an abscess, they might place surgical drains.
• The incision, abdominal lining, and muscles are closed with stitches or staples and a sterile dressing.

Is an Appendectomy Painful?

During an appendectomy, an anesthesia provider will give you sedation and pain medications so you will sleep and not feel pain. 

You will have some discomfort after an appendectomy. Typically, an open appendectomy causes more pain than a laparoscopic appendectomy. Your healthcare team will give you medication to ease the discomfort.

Side Effects and Complications of an Appendectomy

Side effects of anesthesia, surgery, and pain medication might include:

• Nausea
• Pain
• Infection
• Bleeding
• Blocked bowels (bowel obstruction)
• Scarring
• Fistula (abnormal connection of the tube between two organs)
• Adhesions (scar tissue in the abdomen)
• Hernia 

Preparing for Surgery

Your healthcare team will give instructions and ask many questions before surgery. Some examples include:

• Consent: Your healthcare team will provide information about the surgery. You will sign a consent form permitting the team to do the procedure. Don’t be shy about asking questions during this time. 
• Medical history and allergies: Information about your medical history and allergies help your team anticipate any special care they should provide. Inform them if you are pregnant or allergic to medications, tape, latex, or anesthesia.
• Diet: You won’t be able to eat or drink before the surgery. The fasting time frame depends on your specific situation and the preferences of your surgical and anesthesia team. 
• Preoperative care: Your healthcare team will give you instructions about showering and personal hygiene before surgery. They will ask you to remove your clothes and jewelry and wear a hospital gown. 
• Medications: You will likely receive IV fluids, antibiotics, pain medications, nausea treatment, and medication to help you relax before going to the operating room.  
• Time-out: Your surgical team will verify your type of surgery with you and the team before they sedate you and begin surgery.

When you're in the operating room, your anesthesia provider will give you sedation and pain medications before the surgeon begins to ensure you sleep and are pain-free during the operation. 

The anesthesia provider will also put a tube in your throat to help you breathe and monitor your heart rate, oxygen levels, and blood pressure during surgery. 

Appendectomy Recovery

You will go to the recovery room right after the operation. Your healthcare team will monitor your vital signs, such as breathing, heart rate, and level of consciousness (awareness).

In the Hospital

If you stay in the hospital, you will go to your room after you wake up. A team will continue to monitor you. They may give you intravenous fluids, pain medications, and antibiotics and care for any drains or incisions you have. 

Depending on your circumstances and tolerance, your team will offer you ice chips and progress your diet from clear liquids to solid food. 

The team will get you out of bed and moving around as soon as possible and ensure you cough and take deep breaths regularly to help prevent lung problems and blood clots after surgery.

At Home

If you are having a laparoscopic appendectomy, it may be an outpatient procedure. When you are alert and stable, you will go home to recover. Someone will need to drive you because you will still be groggy from the anesthesia. 

Your team will send you home with instructions about the following: 

• Pain management 
• Incision or drain care 
• Diet
• Hydration
• Activity level
• Deep breathing and coughing (to help prevent pneumonia)
• Follow-up instructions 

Following these instructions will help you recover and prevent complications. 

Call your healthcare team if you have:

• Excessive pain 
• Excessive belly swelling
• Fever 
• Signs of infection (redness, swelling, pus)
• Excessive bleeding 
• Loss of appetite or vomiting
• Excessive diarrhea 
• Shortness of breath
• Constipation (no bowel movement/poop for two days or longer)

Outlook

Your recovery period will depend on your type of surgery. Though laparoscopic surgery is less invasive than open surgery, it still takes weeks or months to feel like yourself. 

Most people live a normal life after they recover from their appendectomy. You may have an appendectomy scar, but otherwise, you should be able to return to your regular activities after the initial recovery phase.

Can You Prevent Appendicitis?

Currently, there is no way to prevent appendicitis. The best way to advocate for yourself and your loved ones is to know its symptoms and seek emergency care if you have them. 

Summary

Appendicitis is a potentially life-threatening medical emergency requiring an appendectomy. There are two types of appendectomy procedures: laparoscopic and open surgery. The type of surgery determines procedural steps and recovery. Complications of appendicitis are more common when the appendix ruptures (bursts). An appendix rupture can happen within 48–72 hours after the onset of symptoms, so you should seek immediate treatment if you think you have appendicitis.