Appendicitis

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Appendicitis is an inflammation of the appendix, a small, finger-shaped pouch attached to the large intestine on the lower right side of the abdomen.

It occurs when the appendix becomes blocked or infected, causing swelling, pain, and sometimes rupture. Appendicitis is a medical emergency, as a ruptured appendix can cause serious complications, including infection of the abdominal cavity (peritonitis) and abscess formation. Immediate treatment, usually through surgical removal of the appendix (appendectomy), is necessary to prevent complications.

Causes and Risk Factors

The exact cause of appendicitis is not always known, but several factors can contribute to its development.

Blockage by Hardened Stool or Parasites

The appendix can become obstructed by hardened stool (fecaliths) or intestinal parasites, preventing normal drainage. This blockage allows bacteria to multiply, leading to inflammation and potential infection.

Infections and Swollen Lymphoid Tissue

Infections, including gastrointestinal or respiratory infections, can cause the lymphoid tissue within the appendix to swell. This swelling may block the appendix, resulting in fluid buildup, increased pressure, and inflammation, which can progress to appendicitis.

Diagnosis of Appendicitis

A combination of medical history, physical examination, and diagnostic tests is used to accurately diagnose appendicitis and determine the appropriate treatment.

Symptom Review

The assessment begins with a discussion of the patient’s symptoms, focusing on when the pain started, where it is located, and how severe it is. Information about nausea, vomiting, appetite changes, and bowel habits like constipation or diarrhoea is also gathered to determine whether the symptoms align with appendicitis.

Physical Examination

The physical exam involves applying gentle pressure to the lower right side of the abdomen to check for tenderness, swelling, or pain. Rebound tenderness, where the pain worsens upon quick release of pressure, can indicate inflammation. Muscle tightness or guarding may also be checked to identify irritation in the abdominal area.

Imaging Tests

Ultrasound helps visualise the appendix and detect swelling or blockage. A CT scan produces detailed images of the abdomen and can diagnose appendicitis by revealing an inflamed or enlarged appendix. An MRI, particularly for pregnant women, can provide detailed images of the abdominal area and aid in the diagnosis of appendicitis without the use of radiation.

Blood Tests

Blood tests may be performed to check for signs of infection, such as a high white blood cell count. Although these tests cannot confirm appendicitis on their own, they can support the diagnosis by indicating that the body is fighting an infection.

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Treatment for Appendicitis

The primary treatment for appendicitis is surgical removal of the appendix to prevent rupture and complications. In some cases, non-surgical options may be used, but surgery remains the most effective method for long-term resolution.

Surgical Treatment
Laparoscopic Appendectomy

This is a minimally invasive approach that involves making small incisions in the abdomen. A camera and surgical instruments are inserted through the incisions to remove the appendix. This technique typically leads to faster recovery, less post-operative pain, and smaller scars compared to open surgery.

Open Appendectomy

Open surgery requires a larger incision in the lower right abdomen, providing a clearer view of the abdominal cavity. This approach is preferred if the appendix has already ruptured or if there are complications, such as abscesses or widespread infection. Recovery from open surgery takes longer than laparoscopic surgery due to the size of the incision and the potential for greater tissue damage.

Non-Surgical Treatment

Antibiotics may be used to manage infection and inflammation, either as the primary treatment or before surgery. They are often given to stabilise the condition or for individuals who cannot undergo immediate surgery. However, antibiotics alone may not fully resolve appendicitis, and there is a risk of recurrence.

Preventing Appendicitis-Related Complications

Complications can be prevented through early diagnosis and prompt treatment. Recognising symptoms such as sudden abdominal pain, nausea, and fever and seeking immediate care helps avoid rupture. After surgery, following recovery instructions and monitoring for signs of infection, such as fever or redness at the incision site, reduces the risk of post-surgical complications.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    What is the recovery time after an appendectomy?

    Recovery time varies depending on health and complications. Most people can resume normal activities within a couple of weeks after laparoscopic surgery. Recovery from open surgery may take longer, typically around 4 to 6 weeks.

    Can appendicitis be prevented?

    There is no known way to prevent appendicitis, as it can occur suddenly without specific warning signs. Being aware of symptoms and seeking immediate medical attention is the best way to prevent complications.

    What happens if appendicitis is left untreated?

    If left untreated, the appendix may burst, spreading bacteria throughout the abdominal cavity and causing serious infections like peritonitis or abscess formation. These conditions require urgent medical care and can be life-threatening.

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