Acute appendicitis

Acute appendicitis is a life-threatening condition that requires immediate hospitalization and surgery.


The cause of this condition is an inflammation of the appendix, worm-like part of cecum. In human life this can occur at almost every time but inflammation is unusual in children who are younger than 2 years of age (but they can not be excluded from this diagnosis!). The appendix is not a useless tissue. It contains a vast amount of lymphoid tissue which is important for immune system of human body – we could say that appendix is something like „intestinal tonsils". The exact function of appendix in immune processes is, however, not yet obvious. Because appendix is a “dead end” blindly pieces of chyme could amass and bacterial infection can begin.



The most common symptom is abdominal pain. Inflammatory manifests are quite uncertain at first, there is a dull abdominal pain localized around the navel which might not be so severe, sometimes there are nausea and vomiting. The person is restless and unable to find any pain relief position. The entire condition looks like acute gastroenteritis. However, once the inflammation extends to the vicinity of the appendix, pain status changes. Abdominal pain moves to the right lower abdomen and becomes very intense. The abdomen becomes stiff as a board; we find painful percussion, palpation and decompression. High fever is not typical; the patient has body temperature between 37-38°C. A diarrhea is also not a typical sign in classic appendicitis, constipation more often develops.


Symptoms may differ from above described. Sometimes there may be high fever, diarrhea, the pain can be sometimes on the left side etc.


Quite dangerous is a spread of infection to surrounding tissues or into the abdominal cavity. Surrounding tissues try to demarcate the infection but they do not always succeed. The wall of the inflamed appendix can break as well creating a dangerous intestinal rupture and subsequent peritonitis. Once the inflammation spreads to the abdominal cavity the situation is very serious. The wall of the abdominal cavity has an excellent blood perfusion and so bacterial toxins get easy into blood vessels and cause sepsis (blood poisoning).


The doctor must listen to patient’s complaints and examines him – especially his abdomen where he finds signs of inflammation. Abdominal rigidity and tenderness are caused by reflex contraction of abdominal muscles (Défense musculaire), there is also painful percussion (Pleniés sign), palpation and decompression (Plumberg sign) at the site of inflammation. Laboratory tests show us increased erythrocyte sedimentation rate and elevated CRP. The state of the appendix can be evaluated by using ultrasound. The surgeon often operates without 100% assurance but it is better to perform an operational and remove the tissue than allow emergence of complications.


The classic treatment is quite easy (for skilled surgeon, of course) surgical procedure during which the appendix tissue is removed.


I would like to dedicate this text to memory of Soviet doctor Leonid Rogozov who in 1961 at a distant polar station diagnosed himself an appendicitis and operated himself only using local anesthesia. He was assisted by other polar explorers who held him a mirror to allow him to see into the surgical wound and offered him surgical instruments. The fainted several times because of pain during the operation but performed the operation successfully and saved his own life.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources