Appendicitis Surgery: Symptoms and When to Seek Help

Appendicitis is the commonest cause of emergency abdominal surgery. The lifetime risk is around 7 per cent, meaning roughly one person in fifteen will have it at some point. It occurs most often between the ages of 10 and 30, though it can happen at any age.

What Is the Appendix and Why Does It Become Inflamed?

The appendix is a finger-sized blind-ended pouch at the start of the large bowel. Inflammation begins when its lumen becomes blocked. The commonest causes of that blockage are a hardened piece of stool (faecolith), swelling of lymphatic tissue and, more rarely, a parasite or tumour.

Once blocked, secretions build up inside, pressure rises, blood supply is compromised and bacteria multiply. As this progresses the wall of the appendix weakens and there is a risk of perforation. That generally happens 24 to 72 hours after symptoms begin, which is why time matters so much in appendicitis.

What Are the Symptoms?

The classic course is quite recognisable:

• Pain starts as a dull ache around the navel
• Within a few hours it settles in the right lower abdomen and sharpens
• Loss of appetite appears, often the first symptom
• Nausea, sometimes vomiting, follows
• A mild fever (37.5 to 38.5 degrees)
• Pain worsening on coughing, walking or jolting
• Relief on drawing the right leg up towards the abdomen

Note. This classic picture is not seen in everyone. In pregnancy the appendix is pushed upwards, so pain is felt higher. In children and older people symptoms can be vaguer; in the elderly, fever and pain may stay mild and perforation can be the first presentation. Where the appendix lies backwards, pain may be felt in the back or flank.

How Is It Diagnosed?

The diagnosis does not rest on a single test but on several findings together:

• Examination. Tenderness in the right lower abdomen, pain on sudden release of pressure (rebound) and involuntary guarding of the abdominal muscles are assessed. An experienced examination remains the most valuable step.
• Blood tests. The white cell count and CRP usually rise, but a normal result does not rule appendicitis out.
• Ultrasound. The first-choice imaging, and preferred in children and in pregnancy because it involves no radiation.
• Computed tomography. Gives the highest accuracy in adults where the diagnosis remains unclear.

Conditions That Can Mimic It

Appendicitis is not the only cause of right lower abdominal pain. The differential includes kidney stones, urinary infection, a ruptured ovarian cyst or ectopic pregnancy in women, inflammatory bowel disease, mesenteric adenitis and right-sided diverticulitis. In women the diagnosis sometimes calls for gynaecological assessment.

How Is It Treated?

The standard treatment is appendicectomy, removal of the appendix. In suitable cases it is performed laparoscopically, through a few millimetre-sized openings in the abdominal wall. The advantages of the keyhole approach are:

• Less pain after surgery
• Shorter hospital stay and a faster return to daily life
• Fewer wound infections
• The whole abdomen can be inspected where the diagnosis is uncertain

Open surgery may be needed where perforation has occurred, infection is widespread within the abdomen, or dense adhesions from previous operations are present.

Antibiotics alone. In selected patients without perforation, antibiotic treatment is being studied as an option. In a substantial proportion, however, symptoms recur within a year and surgery is eventually needed. The decision is therefore made individually and with care.

The Cost of Delay

Waiting does not improve appendicitis. Once perforation occurs, infection spreads into the abdominal cavity and peritonitis develops. The operation then becomes more extensive, hospital stay is longer, and the risk of intra-abdominal abscess and wound problems rises.

Important. Do not take painkillers for abdominal pain before being examined. Painkillers mask the picture and delay the diagnosis. Equally, do not eat or drink, and do not put off going to hospital.

What Happens After Surgery?

Where there has been no perforation, hospital stay is usually 1 to 2 days. Eating starts the same or the next day. Those in desk-based work return within a week; 3 to 4 weeks is advised for heavy physical work and sport.

Where perforation has occurred, hospital stay extends to several days and intravenous antibiotics are continued. In either case, see a doctor if fever, increasing abdominal pain, or redness and discharge at the wound appear.

Disclaimer. This article is provided for general information only. It does not constitute medical advice, diagnosis or a treatment recommendation, and it is not a substitute for examination, diagnosis and treatment by a physician. The content is not tailored to any individual and is not intended as advertising. Do not start, change or stop any treatment on the basis of the information here. Consult your own doctor about any decision concerning your health and see a healthcare provider about your symptoms. The site owner accepts no liability for any consequences arising from use of this content. Last updated: 2026-08-11.