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Southern Cross Medical Library

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Appendicitis - symptoms, diagnosis, surgery, recovery

Appendicitis is when the appendix becomes inflamed, swollen and infected, causing increasingly severe abdominal pain and other symptoms. Urgent surgery is required to avert the risk of severe complications caused by the appendix rupturing. Appendicitis occurs more commonly in males than females and, although it can occur at any age, it most commonly occurs in children and adolescents between the ages of 10 - 19 years. It is rare in infants. 

The appendix is a small, hollow, finger-like tube that extends from the beginning of the large bowel on the lower right hand side of the abdomen. It has no known useful function. It is not always known what causes appendicitis but the obstruction of the appendix e.g: with faeces, is one possible cause. Appendicitis appears to occur less commonly in people who eat foods high in fibre and roughage, such as raw fruit and vegetables.


The most common early sign of appendicitis is pain around the tummy button, in the middle of the abdomen. The pain becomes progressively more severe and moves to the lower right side of the abdomen. The pain may be worse with movement.

Other symptoms that may be experienced include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation or diarrhoea
  • Low grade fever
  • Pain on pressing the abdomen.


If appendicitis is suspected it is important that medical attention is sought promptly so that an accurate diagnosis can be made and appropriate treatment given. A diagnosis of appendicitis can be made after a thorough assessment of the clinical signs and symptoms.

Tests undertaken to assist with diagnosis may include:

  • Urine tests (to rule out urine infection)
  • Blood tests - an increased white blood cell count can indicate the presence of infection.
  • Abdominal x-ray
  • Abdominal ultrasound scan
  • CT Scan
Appendicitis can sometimes be difficult to diagnose, particularly in younger children. Because urgent treatment is vital but appendicitis is difficult to diagnose, about 15% of all surgically removed appendixes are found to be healthy.

Complications of appendicitis

Appendicitis is a potentially serious condition; it is important to remove an inflamed appendix before it ruptures. The time between the onset of pain and rupture can sometimes be only a matter of hours, especially in small children and infants.  

If an inflamed appendix does rupture this can cause infection to move into the abdomen and result in peritonitis - an inflammation of the peritoneum, the membrane that covers the abdominal organs.


Surgical removal of the appendix (appendectomy) is the treatment of choice for appendicitis. Antibiotics alone are rarely used as a cure.  

Open appendectomy  
The traditional surgical technique for removing an inflamed appendix involves making an incision in the lower right side of the abdomen. The muscle layers are separated and the appendix is located and removed. The muscle layers and skin are then sewn back together using dissolvable stitches.  

Laparoscopic appendectomy  
This "keyhole" surgical technique involves making three small incisions in the abdomen, and inserting a laparoscope (a fine narrow tube with a small camera at its tip) through one incision and surgical instruments through the other incisions.

The laparoscope allows the surgeon to see the inside of the abdominal cavity on a television screen. The abdominal cavity is inflated with carbon dioxide gas to allow the surgeon to clearly see the area. The surgeon uses the laparoscope to locate the appendix and the surgical instruments to remove it.  

The small incisions in the abdomen are closed using stitches or small paper tapes (steristrips) and are covered by sterile, waterproof dressings.   Antibiotics are usually given before and/or during surgery and may also be given after surgery. The antibiotics may be taken orally as liquid or tablets, or intravenously through a drip in the hand or arm (especially if the appendix has ruptured or peritonitis has developed).


Recovery times after surgery will vary according to the severity of the appendicitis and the surgical technique used.  Laparoscopic appendectomy tends to have a faster recovery time.   Fluids will be given intravenously until the bowel is working effectively. Oral intake of fluid and food begins gradually and increases as tolerated and/or as recommended by the surgeon.  

Most people are able to be discharged home 1-4 days after their appendix has been removed but a longer hospital stay may be required if the appendix has ruptured or peritonitis has developed. Prior to discharge from hospital the surgeon will give clear guidelines on wound care and follow up, what activity can be undertaken and when a return to school or work can be expected.


Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2006) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby-Year Book, Inc. 
Helwick, C. A. (2006) Appendicitis. Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Mills, MI. Thompson Gale.  
Kidshealth (2013) Appendicitis. The Paediatric Society of New Zealand and Starship Foundatiohn.  

Last Reviewed – 19 April 2013   
Go to our Medical Library Index Page to find information on other medical conditions.