Acute Appendicitis

 What is acute appendicitis? 

 Acute appendicitis is a gastrointestinal disorder that is characterised by the sudden and severe inflammation of the appendix, a small finger-shaped pouch protruding from the lower right end of the large intestine. The condition requires prompt medical attention as untreated appendicitis can lead to serious complications, such as a ruptured appendix.

Acute appendicitis is defined by the sudden and severe inflammation of the appendix.

What causes acute appendicitis?

The exact cause of acute appendicitis is typically unclear. However, it is said to be caused by the blockage of the appendix by faecal material, infections, or enlarged lymphoid follicles. Obstructing the appendix causes increased pressure, reduced blood flow, and inflammation.

What are the symptoms of acute appendicitis? Is acute appendicitis painful?

Abdominal pain is a key symptom of acute appendicitis.

Symptoms of acute appendicitis:

  •  Abdominal pain and tenderness: pain in the abdomen which is central at first and eventually moves to the right lower abdomen. Initially, it can be a dull ache, but over time, it intensifies into a sharp, persistent pain. The pain may be accompanied by tenderness in the right lower abdomen, especially when touched.
  • Nausea and vomiting: a feeling of discomfort or queasiness in the stomach, often leading to an inclination to vomit.
  • Loss of appetite: patients may experience a reduced desire to eat, contributing to overall discomfort.
  • Digestive issues: Constipation or diarrhoea may occur.
  • Slight fever: the body's immune response to inflammation in the appendix can lead to an elevated body temperature and chills. 

How is acute appendicitis diagnosed?

Endocrine surgeons will typically employ one or more of the following tests to diagnose acute appendicitis.

  • Physical Examination: A doctor conducts a physical examination, checking for symptoms like abdominal tenderness and pain, focusing on the right lower abdomen.
  • Blood Tests: Blood tests, including a white blood cell count, are performed. Heightened white blood cell levels can indicate an inflammatory response.
  • Imaging Studies:
    • Ultrasound: This non-invasive imaging technique helps visualise the appendix and surrounding structures, aiding in identifying inflammation.
    • Computed Tomography (CT) Scans: CT scans offer detailed cross-sectional images. These images enable a precise assessment of the appendix's condition and the presence of inflammation.

These diagnostic measures are crucial to confirm inflammation of the appendix and exclude alternative causes of abdominal pain. Early and accurate diagnosis of acute appendicitis is extremely critical since the condition can be life-threatening if left untreated.

How serious is acute appendicitis? 

The pain associated with acute appendicitis can vary among individuals, but it is commonly reported as highly uncomfortable and excruciating.

Acute appendicitis is a potentially fatal medical emergency that needs immediate treatment to avoid severe complications. Delayed treatment can result in a burst appendix, leading to the release of bacteria and other harmful substances into the abdominal cavity. This can result in a serious condition called peritonitis, causing widespread infection, inflammation, and even complications like septic shock and organ failure. 

Should I go to A&E with suspected appendicitis?

If you suspect appendicitis, it is crucial to swiftly seek help from a general surgery clinic or call 995 to contact a nearby hospital’s Accident & Emergency (A&E) Department. This is because timely surgical removal of the appendix is crucial to prevent complications and aid recovery.

Ace Specialist Surgery and Endoscopy Clinic offers round-the-clock emergency services for acute appendicitis cases. Patients experiencing acute appendicitis symptoms can seek medical attention at any time for diagnosis and intervention. You can call us any time of the day (24/7), and we will try to arrange an appointment or urgent operation with our endocrine and general surgeon as soon as possible.

What are the treatment options for acute appendicitis in Singapore?

Laparoscopic appendectomy is a minimally invasive surgery (MIS) that is the standard treatment for acute appendicitis.

Appendectomy, the surgical removal of the inflamed appendix, is the most common and definitive treatment for acute appendicitis. It can be done by traditional open surgery or laparoscopic/minimally invasive surgery (MIS). There are two primary surgical approaches: open appendectomy and laparoscopic appendectomy.

Open Appendectomy

Description: An incision is made in the lower right side of the abdomen to remove the inflamed appendix.

Procedure: The surgeon identifies and removes the inflamed appendix. Afterwards, the incision is closed with stitches or staples.

Recovery: Recovery time may be slightly longer compared to laparoscopic appendectomy.

Laparoscopic Appendectomy

Description: Laparoscopic appendectomy is a minimally invasive procedure where tiny incisions are made, and a laparoscope (a thin tube with a camera) as well as specialised instruments, are used for the surgery.

Procedure: The surgeon views the internal organs on a monitor and removes the inflamed appendix using the laparoscope and instruments. The small incisions result in faster recovery and less scarring.

Recovery: Patients typically experience faster recovery times, less postoperative pain, and reduced scarring than open surgery.

Rest assured, your appendix is not an essential organ. Therefore, not only will the removal of the appendix prevent possible complications from acute appendicitis, but it also typically results in no long-term side effects.

Summary

Overall, acute appendicitis, which refers to the sudden and severe inflammation of the appendix, is a medical emergency that requires prompt treatment. Individuals with acute appendicitis should seek urgent medical attention as soon as possible to prevent complications.

Visit Ace Specialist Surgery and Endoscopy

Ace Specialist Surgery and Endoscopy Clinic is skilled in managing cases of acute appendicitis. We are committed to seeing emergency cases. If you have symptoms of acute appendicitis, call us anytime, day or night, and we will strive to schedule an appointment or urgent surgery with our Senior Consultant Endocrine and General Surgeon, Dr Reyaz Singaporewalla, as soon as possible. 

Dr Reyaz has over 25 years of experience in General and Endocrine-Head Neck Surgery. He gained valuable experience and training in Minimally Invasive and laparoscopic surgery as well as Endocrine (Thyroid / Parathyroid / Adrenal) and Breast Surgery under Professor Martin K. Walz and Professor Tom Lennard. Moreover, he has a proven track record in effectively treating acute appendicitis using laparoscopic appendectomy.

Frequently Asked Questions:

Who is at risk of acute appendicitis in Singapore? 

Acute appendicitis can affect individuals of any age. Still, certain factors may increase the risk in Singapore:

  • Age: Young adults and teenagers are more commonly affected, but appendicitis can occur at any age.
  • Gender: It occurs slightly more often in males than females.
  • Genetic Factors: A family history of appendicitis may elevate the risk.
  • Dietary Habits: Diets low in fibre and high in refined carbohydrates may contribute.
  • Infections: Gastrointestinal infections can sometimes precede appendicitis.
Can acute appendicitis be prevented?

While acute appendicitis may not be entirely preventable, some measures may reduce the risk:

  • Nutritious Diet: Consuming food rich in fibre, fruits, and vegetables benefits overall gastrointestinal health.
  • Hydration: Staying well-hydrated supports digestive function.
  • Regular Exercise: Staying physically active may have a protective effect
Can acute appendicitis recur after treatment?

After successful treatment, recurrence is generally uncommon. Still, it is essential to consider the following:

  • Complete Removal: If the entire appendix is removed during surgery (appendectomy), the likelihood of recurrence is significantly reduced.
  • Complications: Complications during the initial episode, such as abscess formation, may slightly increase the risk of recurrence.
  • Non-Removal of Appendix: In cases where antibiotics are used for treatment without surgical removal, there might be a higher risk of recurrence.
  • Individual Variability: While rare, some individuals may experience a second episode of appendicitis.

References

  1. Cleveland Clinic. Appendicitis: Symptoms, Tests, Treatment & Prevention. Cleveland Clinic. Published July 6, 2020.
    https://my.clevelandclinic.org/health/diseases/8095-appendicitis
  2. Mayo Clinic. Appendicitis - symptoms and causes. Mayo Clinic. Published August 7, 2021.
    https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543