Appendicitis: causes, symptoms and complications

Appendicitis: causes, symptoms and complications

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An appendectomy is the dangerous escalation of appendicitis. The worm process and the contents of the intestine burst, and the bacteria that are rife there can get into the abdominal cavity. That can mean death.


Appendicitis (appendicitis) begins with a small inflammation on the appendix, the appendage on the appendix section of the colon. This happens particularly often in children and adolescents. The main symptom is severe abdominal pain in the right lower abdomen. If the treatment starts in time, the inflammation can almost always be managed. To do this, the biologically unnecessary worm process is removed in one operation.

Why does the appendage become inflamed?

The appendix is ​​a ten centimeter long intestinal tube. It ends blindly, and the opening connects it to the appendix. With “appendicitis” it is not the appendix that ignites, but the appendix, namely because the connection to the appendix is ​​blocked. Then liquids accumulate in the worm process. In this way, bacteria from the colon multiply and cause inflammation.

The opening is usually blocked by fecal stones, which is hardened feces; kinking of the worm process in the abdominal cavity can also cause inflammation. Occasionally, foreign bodies such as bone fragments or fruit seeds are also the cause of the constipation. Parasites, viruses and bacteria can also ignite the worm process.


If the child has fallen into the well, the worm has burst, it is too late to pay attention to symptoms. But this is preceded by a longer inflammation. The first signs are acute abdominal pain at the level of the navel or in the stomach area, which migrate into the lower abdomen - on the right side.

Unusual for abdominal pain is now: The abdominal wall is extremely tense and contracts even when touched gently, which causes further pain.

Unspecific symptoms such as fever, nausea and vomiting can also occur. However, inflammation of the worm process in seniors almost always begins without a fever and severe pain, while the pain is most severe in young children.

The breakthrough

If the inflammation worsens and the worm process breaks through, it becomes critical. Bacteria spread with the contents of the intestine into the abdominal cavity, where pus arises and there is often inflammation of the peritoneum.

The pain increases rapidly and spreads all over the abdomen, the muscles tighten and the abdominal wall becomes hard. Those affected have to go to surgery as soon as possible - inflammation of the peritoneum can be fatal.
You should therefore consult a doctor for severe abdominal pain that increases.


The pain of appendicitis in women can easily be confused with menstrual pain, inflammation of the ovaries and ectopic pregnancies.


The doctor presses on certain regions of the abdomen and determines whether the pressure triggers pain. If the lower abdominal pain appears on the right, appendicitis is the obvious cause.

Doctors especially push the “Lanz point”. It lies in the right third of a line between the left and right protrusions of the ilium. Pain associated with pressure on the Mc Burney point, which lies in the right third of a line between the navel and the right protrusion of the ilium, can be an indication of appendicitis. Then the doctor measures fever: with appendicitis, the temperature in the anus is at least one degree higher than under the armpit.

In the laboratory, blood tests provide information - the inflammation increases the white blood cells (immune defense) and the C-reactive protein. An ultrasound examination shows the inflamed worm process. However, safety is only provided by a microscopic examination - and many doctors consider this to be too complex.

A gynecological examination in women shows whether there are other causes such as inflammation of the ovaries.

Healthy worm processes also come under the knife

Doctors also accidentally cut out healthy worms. Up to 40% of the worms that have been cut out are not infected at all.

Is it a botch? It is not that easy. Pain typical of "appendicitis" is drawn from the navel to the right lower abdomen. However, appendicitis shares its symptoms with other symptoms that can have various causes - from an ectopic pregnancy to food poisoning. This means: Before an operation, no doctor can be absolutely certain that the appendage is inflamed.

No clarity even after the operation

Before the operation, ultrasound, physical examination and blood count only give rise to suspicion. Sometimes even the cut out worm does not show whether there is an inflammation.

Antibiotics instead of surgery?

A 2015 study of 530 adult subjects found that 70% of simple inflammations of the appendage can be cured with antibiotics. A CT had previously shown simple appendicitis.

Diagnosis too complex?

Skeptical surgeons consider such a diagnosis too complex. Computer tomography would greatly expand diagnostics. In addition, one would have to observe the patients taking antibiotics in hospital. This is disproportionate to the fact that one in three patients would ultimately be operated despite CT and antibiotics.


If you suspect that your appendix is ​​inflamed or breaks through, do not eat anything and go to the doctor or better still to the hospital immediately and have it examined.

An inflamed worm process is almost always removed, i.e. cut out in one operation. The following applies here: the earlier, the better. It makes no sense to “save” a biologically unnecessary organ, but it makes a lot of sense to avoid a dangerous appendix breakthrough.

If the appendix has already broken through, immediate surgery is not possible. Now the infection has to be suppressed - with antibiotics and liquids that are inserted through a vein. If the patient's condition improves, the operation is carried out.

After the operation, you stay in the hospital for several days.

The operation

Removal of the appendix is ​​one of the most common operations on the abdomen. The surgery is traditionally open, so the surgeon cuts open the abdomen. A more modern approach is a minimally invasive approach with three small cuts, the so-called keyhole technique. This has the advantage that instead of a longer cut scar, only three scars that are barely visible remain.

Both procedures last between 20 and 30 minutes.

During the open surgery, the surgeon opens the right lower abdomen with a cut about six centimeters long. Then he separates the appendix from the appendix and takes it out. He sews the opening with the so-called tobacco pouch seam from the inside out; the threads dissolve by themselves.

If the worm process has broken through, the doctor mechanically rinses out the open abdominal cavity and removes feces, bacteria and pus. Drainages also drain the inflammatory fluid out of the body.

In laparoscopic appendectomy, the surgeon inserts an endoscope into the abdominal cavity that blows carbon dioxide gas into the abdomen. A camera shows the entire abdomen. Two more cuts in the lower abdomen bring additional guide sleeves with micro instruments to the worm process.

The surgeon now uses two self-knotting loops, uses them to separate the worm process from the appendix and takes it out of the body with a guide sleeve. Then he sews the three small steps inside out.


Every surgical intervention in the body carries a risk, but complications are extremely rare when removing the appendix. As with all operations, bleeding can occur, the internal wounds can become infected.

After removing the appendix, an abscess in the abdominal wall can occur. Pus collects here, which the doctor has to remove. However, this is more common in open surgery because of the size of the cut.

The Douglas abscess is more dramatic. It develops about a week after the operation and is associated with high fever and pain. Here the pus collects at the lowest point in the abdominal cavity and a second operation is pending.

After the operation

If there are no complications, the patient can drink again a few hours after the operation and a day later he can eat again. But this is not a “law”, rather the doctors observe exactly how the intestinal function regenerates.

Most patients are discharged from the hospital after four days, but should be spared for several days. Walking in particular causes pain and those affected have to take longer breaks. They can usually go back to work after two to three weeks. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Professional Association of Pediatricians e. V .: Appendicitis (accessed: August 6, 2019), kinderaerzte-im-netz.de
  • Herold, Gerd: Internal Medicine 2019, self-published, 2018
  • Merck and Co., Inc .: Appendicitis (accessed: Aug 6, 2019), msdmanuals.com
  • Charité - Universitätsmedizin Berlin: Appendicitis (appendicitis) (accessed: August 6, 2019), kinderchirurgie.charite.de
  • Mayo Clinic: Appendicitis (accessed: August 6, 2019), mayoclinic.org
  • National Institute of Diabetes and Digestive and Kidney Diseases: Appendicitis (accessed: August 6, 2019), niddk.nih.gov
  • American College of Surgeons: Surgical removal of the appendix, as of 2017, facs.org
  • UpToDate, Inc .: Acute appendicitis in adults: Clinical manifestations and differential diagnosis (accessed: August 6, 2019), uptodate.com

ICD codes for this disease: K35-K37ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Appendicitis - The only video you will need! (October 2022).