What is Appendicitis?
Appendicitis is a condition where the appendix becomes inflamed. The appendix is a small, tubular organ attached to the large intestine. Apendicitis is the most common cause of abdominal pain requiring surgery in the United States. If untreated, apendicitis can cause the appendix to burst, leading to the spread of bacteria in the abdominal cavity, which can be severe and sometimes fatal [1].
Causes of Appendicitis
The appendix is a complex organ, which is not fully understood. There is insufficient knowledge about the roles of the appendix in the healthy body, as well as in disease. However, it is believed that the primary cause of appendicitis is a blockage. This can be a result of impacted fecal matter, enlarged lymphoid follicles, presence of parasites, traumatic injury, or tumors. When the appendix is blocked, it becomes a shielded habitat for bacteria to multiply in, leading to inflammation, swelling and accumulation of pus. This in turn causes painful pressure in the abdomen [1].
Clinical Presentation of Appendicitis
The primary presentation of appendicitis is abdominal pain (pain in the stomach). This pain usually starts near the belly button, and can become more severe and shift to the lower right side of the abdomen. Besides pain, other symptoms can include loss of appetite, fever, nausea and vomiting [1].
Treatment for Appendicitis
The primary course of treatment for appendicitis is surgical removal of the appendix, which is referred to as appendectomy. Prompt intervention is needed, as untreated appendicitis can rapidly progress into a serious abscess or rupture of the appendix, which can cause fecal matter and bacteria to contaminate the abdominal cavity, leading to a serious infection known as peritonitis [1].
Multiple treatment options are available, including:
- apendectomy - by far the most common treatment,
- drainage of the abscess using a needle without surgery.
These are administered in addition to supportive treatment, comprised of:
- antibiotics to suppress the infection,
- pain relievers,
- administration of fluids intravenously,
- and a liquid diet [1].
Appendectomy can be performed either as an open surgery, where an incision is made, or laparoscopically, where several small incisions are made and thin instruments are inserted in the abdominal cavity, with a camera to guide the surgeon [1]. Regardless of the approach, the surgery involves removing the appendix and restoring the intestinal wall. In the case of a burst appendix, the surgery also involves cleaning the abdominal cavity [1].
In some cases, appendicitis may improve without surgery, however, this is rare. Antibiotics may help manage the infection, and if there is an abscess present this can be drained by inserting a needle through the abdominal wall [1]. This is a procedure that is guided by ultrasound or CT [2].
Can you die from appendicitis?
With modern healthcare, appendicitis can be managed very effectively. However, especially in the case when appendicitis is untreated, it can be fatal.
The appendectomy is a very safe and well-tolerated procedure. In a study on 678 patients undergoing an appendectomy over a 2-year period, the 30-day post-operative mortality was recorded as 0% [3]. This suggests that with appropriate surgical intervention, the survival rate for acute appendicitis is very high.
However, the case is very different for untreated appendicitis, or when the condition is managed late. Untreated infections can lead to formation of abscesses, intestinal perforation and peritonitis, which can significantly increase the mortality. With fecal peritonitis, the 100-day relative survival rate was recorded as 44% [4].
Summary
In summary, while the survival rate for treated acute appendicitis is very high, untreated appendicitis can lead to serious complications that significantly increase the risk of mortality. Therefore, it is important to seek medical attention immediately when appendicitis is suspected.