What to know about appendicitis

Musician John Mayer is recovering after postponing a concert in New Orleans earlier this month to undergo an emergency appendectomy. Luckily for Mayer, it’s a very common procedure and complications are rare.

“If you talk to family members or friends, you’re going to find someone who’s had it done,” says general surgeon Walter Hayne, MD, with Orange Park Medical Center in Orange Park, Florida. “And as long as it’s caught early, usually, people do very well.”

What is an appendectomy?

An appendectomy is the surgical removal of the appendix when an infection has made it inflamed or swollen. This infection, called appendicitis, is considered an emergency because it can be life threatening if untreated. Occasionally, an inflamed appendix bursts after a day of symptoms. So it's very important to have it removed as soon as possible.

What is the appendix, what does it do?

The appendix is a small organ – about the size of your finger – located in the abdomen. “The appendix is what we call the vestigial organ, which means no one knows what its function is,” says Hayne. “It’s like your tonsils, it has no clear function.”

How do you get appendicitis?

One end of the appendix is closed and the other opens into the large intestine, the organ that absorbs water from waste (or stool) and moves it out of the body through the anus. When the opening to the appendix gets congested, it can become inflamed and swollen. Hayne says this can be caused by any number of things, such as a piece of stool, seeds, nuts, or even lymph nodes around the base of the appendix that occlude the opening and allow bacteria to build up. When bacteria inside the appendix builds up and multiplies, appendicitis occurs.

What are symptoms of appendicitis?

When symptoms first appear, they could be fairly mild. Hayne says early symptoms are almost flu-like: “They’ll feel vaguely uncomfortable in their abdomen, and lack of appetite is another classic symptom.” But those milder symptoms are usually short-lived. As the appendix becomes more inflamed, the vague, dull pain in the abdomen experienced at the onset of symptoms transitions to persistent and sharp pain in the right lower abdomen. “Within four to six hours of the onset of symptoms, they get what we call right lower quadrant tenderness,” says Hayne, referring to the sharp, localized pain.  

In addition to abdominal pain and loss of appetite, other signs of appendicitis to watch for include fever, nausea, vomiting, diarrhea and sometimes painful or frequent urination.

If appendicitis is not treated, the inflamed appendix can burst 24 to 72 hours after the symptoms begin – spilling the bacteria into abdomen and increasing the risk of complications.

How is appendicitis diagnosed?

Depending on how quickly the patient arrives at the hospital, Hayne explains, the doctor will usually order lab work and either an ultrasound or a CAT scan to confirm or rule out appendicitis. If the patient has appendicitis, “The lab work will show an elevated white blood cell count, indicating an infection,” Hayne says “And usually the ultrasound or a CAT scan will show this little tube the size of your finger in the right lower quadrant of your abdomen with inflammation around it.”  

Are there different types of appendectomies?

“The standard in the U.S. is to have laparoscopic appendectomy,” says Hayne. Laparoscopy is a type of surgery that uses a tiny video camera called a laparoscope to help surgeons see inside the body. The thin tube of the laparoscope is inserted into the body through a small incision and guided to the appendix to act as the surgeon's "eyes." Other small incisions are made so medical instruments can be guided to the area, and the entire operation is done while the surgeon looks at a TV monitor.

A laparoscopic appendectomy usually means a shorter and easier recovery time. “Studies show that if it’s done laparoscopically, patients take less pain medicine, they have less post-op pain and they’re in the hospital a shorter time. If it’s not ruptured, usually the patient can go home that day or the next morning.”

But there are some cases when open surgery is required instead of laparoscopic surgery. “If it’s perforated and the person’s really sick, sometimes it requires open surgery,” says Hayne. An open appendectomy is the "traditional" way of removing an infected appendix. Basically, a surgeon makes a large incision in the abdomen and locates the infected appendix. The appendix is cut away from the large intestine and removed from the body. The incision is then closed with stitches.

Hayne says this type of surgery, though sometimes necessary, can make for a longer and more painful recovery. The key, he says, is to come in for treatment ASAP: “If it’s caught in less than 12 hours, the risk of it rupturing is low and you can have a pretty routine recovery.”

How do you know if you should go to the ER?

Stomach pain doesn’t always mean you have a serious illness. If you’re experiencing abdominal pain that’s abnormal for you and that lasts more than a few hours, Hayne suggests calling your doctor to discuss your symptoms. “If it’s severe pain associated with chills or lack of appetite,” he says, “they should go to the ER.”