What are the symptoms of appendicitis?

DEAR DOCTOR K:

Every time my husband has abdominal pain, he worries that it’s appendicitis. Can you tell me the actual symptoms so I can assure him he’s fine?

DEAR READER:

Many different conditions can cause abdominal pain. The cause of most abdominal pain is a temporary and simple disorder, such as a pocket of gas trapped in the intestine, or stomach acid causing heartburn.

But serious conditions also cause abdominal pain, and appendicitis is one of the most common of those serious conditions. It affects one in every 500 people in the United States each year.

Appendicitis is an inflammation of the appendix. Your appendix is a small, fingerlike tube. We don’t know of anything good the appendix does for us — we just know it can cause trouble.

Many people, including many of my patients, worry about appendicitis whenever they get a pain in their belly. It’s worth worrying about: Appendicitis can have serious and life-threatening consequences. Left untreated, an inflamed appendix can burst. The infection can then spread throughout the abdominal cavity and into the bloodstream.

The appendix hangs from the lower right side of the large intestine. If your husband’s pain is predominantly on his left side, it’s probably not appendicitis. (See illustration.)

Location of appendix

Illustration of appendix location

 

Appendicitis causes the following symptoms:

Abdominal pain: This usually starts just above the belly button, then moves over several hours to the right lower side of the abdomen.

  • Nausea
  • Vomiting
  • Abdominal swelling
  • Pain when the right side of the abdomen is touched
  • Low-grade fever
  • Inability to pass gas
  • Change in normal bowel pattern

Appendicitis is an emergency and requires immediate attention to avoid the risk of a ruptured appendix. If your husband ever has symptoms of appendicitis, he should contact his doctor right away.

The doctor will ask about his symptoms, then check for pain in the lower right abdomen. Blood tests, ultrasound or a computed tomography (CT) scan can also provide evidence for or against the diagnosis.

When the symptoms, physical examination and tests all strongly suggest that a person has appendicitis, surgery to remove the appendix (an appendectomy) is required, as soon as possible. That’s because a ruptured appendix can be life-threatening, while an appendectomy is a relatively low-risk operation.

If doctors think the likelihood of appendicitis is high — even without blood tests or imaging studies — they’ll operate. If doctors think appendicitis is unlikely but still possible, they’ll continue to observe a person in the emergency room, and operate later if the person doesn’t get better.

Still, our diagnostic accuracy is not perfect: In about 10 percent to 25 percent of appendectomies, the appendix is normal. It’s usually removed anyway, since it’s easy to do once the abdomen has been opened, and because it could cause trouble in the future.

Related Information: Harvard Health Letter