Quick answer
What is appendicitis?
Appendicitis is inflammation of the appendix — usually causing pain that starts near the belly button then moves to the lower right abdomen, with nausea and fever. It needs urgent hospital assessment — untreated appendix can burst (perforate) causing peritonitis. Treatment is usually surgery to remove the appendix (appendicectomy). Go to A&E if you have worsening abdominal pain with fever — do not wait.
Appendicitis — inflamed appendix
The appendix is a small pouch attached to the large intestine — function unclear. Appendicitis is inflammation, usually from blockage (faecalith, lymphoid swelling) and bacterial overgrowth.
It is the most common abdominal surgical emergency in the UK — time matters — rupture increases morbidity significantly.
Symptoms — classic progression
Early (first 12 to 24 hours):
- vague central abdominal pain — around navel
- loss of appetite — key feature in children and adults
- nausea — vomiting often after pain established
Later:
- pain migrates to right iliac fossa (lower right)
- localised tenderness
- fever
- guarding — muscles tense on examination
- pain worse with movement, coughing, car journey bumps
Atypical presentations:
- children — diffuse pain early
- elderly — less dramatic — higher rupture risk before diagnosis
- pregnant women — appendix displaced upward — right flank pain
- retrocaecal appendix — back or pelvic pain
When to seek emergency care
Go to A&E / phone 999 if:
- worsening abdominal pain with fever
- cannot stand straight or walk due to pain
- rigid board-like abdomen
- collapse, confusion — sepsis
Do not:
- eat or drink before assessment (surgery may need empty stomach)
- take laxatives or enemas
- assume ” tummy bug” if pain localises and worsens
Diagnosis
No single perfect test — clinical judgement central:
- history and examination — McBurney’s point tenderness
- blood tests — raised WCC, CRP
- urine — exclude UTI/pregnancy
- imaging:
- ultrasound — children, young women (avoid radiation)
- CT abdomen — adults — high accuracy
- MRI — pregnancy
Scores (Alvarado) aid decision — not replace clinician.
Treatment
Surgery — standard
Laparoscopic appendicectomy:
- keyhole — 3 small incisions
- appendix removed
- same-day or overnight stay typical
Open surgery if perforated, abscess, or technical difficulty.
Antibiotics alone
Selected studies support antibiotics-first strategy for uncomplicated appendicitis — recurrence ~30% at 1 year — not universal NHS practice — discuss in hospital if offered.
Complicated appendicitis
Perforation/abscess:
- IV antibiotics
- percutaneous drainage of abscess sometimes
- interval appendicectomy weeks later
Recovery
Uncomplicated laparoscopic:
- discharge 24 to 48 hours
- paracetamol for pain
- shower next day — keep wounds clean
- driving when can emergency stop — usually ~1 week
- work — 1 to 2 weeks desk job
- heavy lifting — avoid 4 to 6 weeks
Ruptured appendix:
- longer hospital stay
- IV antibiotics course
- bowel injury rare complication
Appendicitis vs other causes
| Condition | Clues |
|---|---|
| Gastroenteritis | Diarrhoea prominent, diffuse cramp, contacts ill |
| UTI/kidney stone | Urinary symptoms, flank pain |
| Mesenteric adenitis | Post-viral, less progression |
| Ovarian cyst | Women — mid-cycle, gynae cause |
| Ectopic pregnancy | Positive test, shoulder tip pain — emergency |
Pregnancy test mandatory in women of childbearing age.
Prevention
No reliable prevention — high-fibre diet theorised but not proven to eliminate risk.
Early hospital presentation when symptoms fit — best outcome modifier.
Central pain moving right, fever, cannot eat — A&E tonight, not morning GP slot.
Common questions
- What are the symptoms of appendicitis?
- Pain starting around navel then shifting to lower right abdomen, worsening over hours. Loss of appetite, nausea, vomiting (often after pain starts), fever, constipation or diarrhoea. Coughing or walking jolts pain. Pressing left side hurts right (Rovsing sign) — clinical clue for doctors.
- Where is appendicitis pain located?
- Typically lower right abdomen — McBurney's point — one-third from hip bone to navel. Early pain may be central or around umbilicus. Location varies — pregnant women, elderly, and those with unusual appendix position may have atypical pain.
- Can appendicitis go away on its own?
- Occasionally inflammation settles — but cannot safely distinguish from progressing appendicitis without hospital assessment. Delay risks rupture — peritonitis, abscess, sepsis. Always seek urgent care for suspected appendicitis.
- How is appendicitis treated?
- Usually laparoscopic (keyhole) surgery to remove appendix — appendicectomy. Antibiotics given. Selected cases — antibiotics alone with delayed surgery if needed — research ongoing; most UK practice is early surgery. Abscess may need drainage before surgery.
- How long is recovery from appendix removal?
- Keyhole surgery — often home within 24 to 48 hours, return to normal activities 2 to 4 weeks. Open surgery or complicated rupture — longer recovery. Follow hospital advice on wound care and driving.
- What happens if your appendix bursts?
- Perforation spills bacteria into abdomen — peritonitis, abscess, sepsis. Needs emergency surgery, IV antibiotics, possible longer hospital stay and bowel complications. Early treatment prevents most ruptures.