Appendicitis

Inflammation of the appendix. Common, and the presentation in children, older people and pregnancy is what catches people out.

What it is

Appendicitis is the commonest surgical emergency of the abdomen, affecting around 1 in 13 people at some point, most often between 10 and 20.

The classic description is well known: pain starting around the navel, moving to the lower right, with nausea and fever.

The reason it earns an entry is that in the groups where it is most dangerous, it does not present classically.

In young children the pain is often vague and central, and they present late with a perforated appendix. In older people, symptoms are milder and the diagnosis is delayed, with a substantially higher complication rate. In pregnancy the appendix is displaced upward, so the pain is in the wrong place.

Perforation leads to peritonitis and sepsis.

Signs you might notice

Pain beginning around the navel and moving to the lower right abdomen over hours.

Pain worse on movement, coughing or going over a bump in the car.

Loss of appetite, which is a genuinely useful sign, particularly in children.

Nausea, vomiting, low-grade fever.

Tenderness in the lower right, with guarding.

In someone who cannot describe pain: refusing food, drawing knees up, distress on being moved, or a change in behaviour with fever.

How it can affect day-to-day life

Delay is the whole risk. The complication rate rises sharply once the appendix perforates, and perforation rates in young children and older people are high precisely because of delayed presentation.

Painkillers do not mask appendicitis to the point of danger; withholding pain relief while waiting for assessment is outdated practice.

Non-operative management with antibiotics is used in selected cases, though most people still have surgery.

Supporting someone well

Take abdominal pain with loss of appetite seriously, especially in a child.

Do not give laxatives or apply heat to an undiagnosed abdominal pain.

Do not eat or drink once surgery is a possibility, but do say so at triage.

Get reassessed if the pain moves, worsens or persists. Being sent home once is not a diagnosis.

In older people and in pregnancy, be more suspicious rather than less, since the presentation is misleading.

For somebody who cannot report symptoms, treat a new refusal to eat with distress on movement as a possible abdominal emergency.

Where to get help

Same-day assessment for suspected appendicitis; A and E for severe pain, fever or vomiting.

Sudden relief of severe pain followed by feeling much worse may mean perforation. Go immediately.

Call 999 for a rigid, board-like abdomen or collapse.