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A Quick Guide to Appendicitis

  • 21 Nov 2022
  • 2 mins

What are the symptoms of appendicitis and the needed treatments? Dr. Richard Sim, Senior Consultant General and Colorectal Surgeon, takes us through what to look out for in understanding this diagnosis.

Defining Appendicitis

Appendicitis is inflammation of the appendix which usually develops when the lumen of the appendix is blocked. This may be due to a solid ball of fecal material called a fecolith present, swollen gut lining or lymphatic tissue caused by bacterial or viral infections, gut parasites, or a mass, for example from cancer.

The appendix then becomes distended and may progress to infection, pus formation, perforation, and gangrene.

Symptoms of Appendicitis

The early symptoms may include fever, nausea, vomiting, constipation or diarrhea, and dull pain above or around the belly button.

Medical consultation is required if the pain becomes sharply localized to the right lower and/or lower abdomen after several hours, especially if the pain is aggravated by coughing or walking.

Treatment Options

Recent studies suggest that as many as 70% of patients with a first presentation of uncomplicated appendicitis (not perforated and with no abscess, usually confirmed on CT scan) can be safely and successfully treated with antibiotics alone, although other studies have suggested that 40% of conservatively treated acute appendicitis will require surgery within 5 years, mainly for recurrent appendicitis which is more likely in the presence of fecoliths.

All patients with appendicitis should be examined and counseled by a surgeon to determine their preference in a shared decision-making process.

It should be noted that antibiotic treatment alone is not recommended for children under 12 years, pregnant patients, elderly patients over 60 years, and patients with severe signs of infection, or who are immunocompromised (e.g. transplant or cancer patients).

In addition, it should be pointed out that although there may be cost saving with non-operative management, this should not be the main consideration in making the choice.

Patients might choose surgery to reduce the risk of:

  • Re-admission to hospital
  • Needing a drain put into the abdomen or pelvis to remove pus
  • Recurrent appendicitis
  • Missing a cancer

They might choose antibiotics to reduce the risk of:

  • Surgery
  • Missing more days of work for themselves and their caregivers in the short term

To put this in perspective, it might be a reasonable choice for a patient to have antibiotic treatment if he or she is hosting a wedding dinner at the upcoming weekend, or if the risk of surgery is advised to be high because of active COVID infection, but it would be wise to opt for surgery if the plan is to make a long trip to a rural area in the next year.

Preventing Appendicitis

There is no proven way to prevent or lower the risk of appendicitis but having a regular bowel habit and taking a high fiber diet may be helpful.

Contributed by

Dr. Richard Sim
RSim General & Colorectal Surgery Pte Ltd
Farrer Park Hospital