Health x Wellness

6 questions about appendicitis

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Appendicitis is the inflammation of the appendix. The appendix is a 5 to 10-cm long tubular blind-ending pouch, about the thickness of a pen, which is attached to the beginning of the colon. It is located in your right lower abdomen.

The Active Age (AA) discusses appendicitis with Dr Melvin Look (ML), a Consultant Surgeon in Gastrointestinal, Laparoscopic and Obesity Surgery, with a special interest in Endoscopy and the treatment of Digestive Diseases.

AA: How often do you see patients with appendicitis in your clinic? How common is appendicitis in Singapore? How have the numbers changed over the last five years?

ML: Appendicitis is one of the common emergency surgical conditions that I see in my practice. The typical presentation is acute abdominal pain and most of these patients will then be admitted through the hospital Emergency Department for suspected acute appendicitis. I would see 4 or 5 cases every week for this and after further tests about half will be confirmed to have appendicitis. 

There are no reliable statistics about this condition in Singapore, but worldwide data show a stable incidence of between 100 to 150 cases per 100,000 person-years in Western countries. The incidence from newly industrialised countries, however, seems to be rising. Although appendicitis can happen at any age, the peak incidence is in the second and third decade of life.

AA: Some people say that appendicitis is caused by jumping, running and other vigorous activity immediately after eating. Is there any truth in this?

ML: Exercise and vigorous activity after a meal will not make you get appendicitis, but the converse may be true. If you discover a pain in the right lower abdomen when you run or jump, this could be an early sign that you may be having appendicitis!

AA:  What activities, whether food and drink-related or what type of health conditions can give rise to the inflammation?

The usual cause of appendicitis is blockage of the entrance of the appendix by fecal debris or other causes, which leads to swelling of the appendix, bacterial overgrowth and subsequent inflammation. If treatment is not sought the appendix can become gangrenous and perforate, leading to the serious complication of peritonitis or generalised infection of the abdominal cavity.

Eating fruits and plants with indigestible residuals may occasionally be the cause of appendicitis. We sometimes find seeds and nuts blocking the opening of the appendix in patients requiring surgery for appendicitis.

AA: What are the signs of appendicitis and how are they different from a usual stomachache?

ML: In early appendicitis you may get central and upper abdominal discomfort that comes and goes, symptoms that are quite similar to a usual stomach ache.

Within a day however, the pain becomes more serious and constant, and becomes localised to the right lower abdomen where the appendix is located. You may also feel very unwell and have fever and vomiting.

If you see a doctor and appendicitis is suspected, we will usually perform a CT scan to confirm the diagnosis. An ultrasound of the appendix is a good alternative if the exposure to radiation is a concern, such as in children and pregnant women.

AA:  What does the treatment involve? Does it always involve removing the appendix and a prescription of antibiotics? What else is usually involved in the treatment?

ML: Urgent surgery to remove the appendix is usually recommended if you are diagnosed with acute appendicitis. This can be done by conventional open surgery or by laparoscopic surgery.

I prefer the latter as recovery after keyhole surgery is faster and there are less risks of wound infection. You will also be given a course of antibiotics to treat the infection. The majority of patients can be discharged from hospital 2 to 3 days after surgery, and there should be no possibility of another episode of appendicitis in the future.

In a small group of patients with uncomplicated appendicitis which is diagnosed in the early stage, antibiotic treatment alone may be successful in treating the inflammation without surgery in 7 out of 10 patients.

Patients who opt not to have surgery are, however, at risk for a second episode of appendicitis in the future. In fact, about 40 percent of them do end up with surgery eventually within the next year.

In some patients with acute appendicitis the infection may become so bad that an inflamed mass forms around the appendix, making surgery difficult and hazardous. In these situation we prefer to control the inflammation first with antibiotics and come back to remove the appendix many weeks later.

For patients who decide to preserve their appendix, the chances of a second bout of appendicitis in the future is fairly significant.

AA: How will our gastrointestinal function be affected with the appendix’s removal?

ML: The appendix is an important part of the digestive tract in herbivorous vertebrates as it may be involved in the digestion of plants. As humans evolved our appendix has become vestigial in significance. It seems to have a small role in our immune function and is a useful sanctuary for our gut microbiota, the good bacteria in our digestive tract that helps to keep our gut healthy. In the event of gut infection or food poisoning, the appendix seems to have a role in producing the microbiota to re-populate the gut.

There is no real harm should you require surgery to remove the appendix in the event of appendicitis, but it may be good to include some probiotics in your diet, especially when you have a gut infection or consume antibiotics for any other reasons.

Dr Melvin Look is the Director of PanAsia Surgery in Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital. He is a Consultant Surgeon in Gastrointestinal, Laparoscopic and Obesity Surgery, and has a special interest in Endoscopy and the treatment of Digestive Diseases. He underwent various training awards at the National Cancer Center Hospital in Tokyo, Royal Infirmary of Edinburgh UK, Mount Sinai Medical Centre New York, and Washington Cancer Institute in Washington DC.