Family doctor

What is an appendix?

The appendix is a small hollow tube, about the size of a little finger, that hangs off the beginning of the large intestine (bowel). There is no recognised important function for the appendix, and it seems to be a vestige of prehistoric times. Thus you can live perfectly normally without it.

What is appendicitis?

Appendicitis is a general medical term meaning inflammation. Hence appendicitis means inflammation of the appendix. Just as you can develop a sore throat for no particular reason, so can you develop appendicitis out of the blue. However, it is more common in flu season. Sometimes a small solid lump of stool (faecolith) can obstruct the appendix, and lead to appendicitis, and occasionally a tumour may also obstruct and set up appendicitis.

It is most common in the younger generation, but can occur at any age, even the elderly. It is uncommon in the elderly, and thus the diagnosis may be delayed, which is the main reason for a worse prognosis in this age group.

What are the symptoms?

In full blown appendicitis, the infection gets progressively worse, so the symptoms get progressively worse. Nearly always, the first inkling of something amiss is the onset of tummy pains, followed by loss of appetite, then nausea and vomiting.

The pain gets progressively worse, and movement aggravates thepain. So much so that even the bumps in the road to the doctor are felt by the patient.

Although the pain may start as a generalised central tummy (abdominal) discomfort, it usually worsens and settles in the right lower tummy (abdomen), and becomes very tender to push on this area.

Unfortunately, it is also very common to present in a more unusual pattern which makes diagnosis difficult.

What tests are useful?

Rarely are any tests useful. It still relies on the wisdom and clinical skills of an experienced surgeon. Other tests may be helpful to monitor a patient, or decide on treatment options. Often a urine test and a blood count may be done to assist diagnosis.

An ultrasound scan may show a swollen appendix, but the clinical signs are usually quite apparent by this time, and the diagnosis able to made without the scan. The absence of a good diagnostic test is one of the reasons for a normal appendix to be removed.

Treatment for appendicitis

Antibiotics are rarely used for a cure. Surgical removal is the best option.

Sometimes, a patient will develop an appendix abscess, which may be amenable to drainage without surgery. This involves a little local anaesthetic into the skin over the tummy abscess, and using ultrasound, much like a radar, to guide a fine tube through the skin into the abscess, and drain the pus out.

A routine operation, involving a cut to surgically remove the appendix, is still the most commonly used operation. Recovery depends on the degree of infection, and the patient's age, but the average time in hospital is 5 days. Full return to physical activity is also variable, but usually takes several weeks.

Surgeons adept at laparoscopic (keyhole) surgery prefer this modern technique. Small nicks allow for less pain, a better cosmetic result, and most patients go home the next or following day. Patients usually return much more rapidly to full activity with this method.

Can I choose which operation I should have?

Of course, but it may not be practical. The doctor in the public hospital will usually be a doctor training to be a surgeon (Registrar), and although very experienced in the open technique, may not have yet had specific training in laparoscopic removal of appendicitis.

For those with private insurance, an experienced specialist laparoscopic surgeon may be available in your area for after hours work. Anyone can use the private system, but it is rather expensive without private insurance. The quick return to work may in fact make it cost effective.

Any special instructions after surgery?

Nothing too unusual. There will be general instructions given regarding wound care and follow-up. There is no special diet. Activity depends on the technique used. Check your insurance before driving, to make sure there is no prohibitive clause after an operation. Going back to work depends on how physical your job is, and the operative technique used. Your surgeon should give you full instructions on your discharge regarding all these points.

Seeking help

If you have worsening symptoms and abdominal pain, do not delay seeking medical help as the outlook becomes much worse if an appendix ruptures due to delayed diagnosis.