Appendicitis starts as abdominal pain that is easy to mistake for almost anything. Within a few hours, the picture usually changes. Below: what happens in the body hour by hour, how it is checked in the hospital, and why delay costs dearly.
What appendicitis is
Appendicitis is inflammation and infection in the appendix, the worm-shaped pouch of the cecum, a part of the intestine. The inflammation is caused by microorganisms — most often E. coli, staphylococcus, streptococcus — which enter the wall of the appendix mostly from the intestinal cavity. Acute appendicitis is treated in the hospital urgently. A chronic form also exists: it manifests as constant aching pain in the lower right and bowel disturbances.
The first hours: how the pain behaves
At first, the pain appears in the middle of the abdomen, near the navel. After a few hours, it usually moves to the lower right area of the abdomen and becomes stronger. This migration is called Kocher's sign. Sometimes the pain starts in the upper abdomen rather than near the navel and also migrates to the lower right. The pain intensifies when you move, cough, or press on that area. It becomes slightly easier if you pull your knees to your chest. During examination, the doctor looks for abdominal muscle tension — guarding.
Other symptoms
Along with the pain, nausea and one-time vomiting usually appear, and appetite disappears. The temperature rises to 38 °C — elevated temperature here is only an accompanying sign, not a standalone problem. The pulse quickens, and the white blood cell count rises. Constipation may occur, and in children — one-time diarrhea. Some people need to urinate more often. In older adults, sudden confusion is possible.
Atypical cases
Not everyone's appendicitis looks classic. The pain may be milder, develop more slowly, or be felt in a different place. This more often applies to pregnant women, young children, and older adults. The appendix does not always lie in the typical position: it may be in the pelvic area, behind the cecum, or under the liver. Then the pain radiates differently, and it is harder for the doctor to orient right away.
Why you can't wait
If appendicitis is not treated quickly, the appendix can rupture. At the moment of rupture, the pain sometimes suddenly eases for a short time. Then comes severe pain throughout the abdomen, and moving becomes very painful. This is not relief but a trap. The inflamed appendix perforates or progresses to diffuse peritonitis — inflammation of the peritoneum. After a rupture, recovery takes longer than after timely surgery. Laxatives, enemas, and painkillers before examination blur the picture — doctors warn about this.
Diagnosis and what comes next
In the hospital, the surgeon palpates the abdomen to assess pain and tension. Next come tests: blood test, urine test, ultrasound or CT, and a pregnancy test if needed. No test shows appendicitis with one hundred percent certainty. Symptoms resemble a urinary tract infection, kidney or gallbladder stones, bowel problems, and gynecological conditions. You cannot make the diagnosis yourself — with such pain, seek help. That is why doctors sometimes observe for several hours how the condition changes. If the picture is clear or rupture is suspected, they will not wait and will offer surgery. The standard is removal of the appendix; the body does not need the appendix. After laparoscopy, patients are sometimes sent home the next day; after open surgery or complications, they stay in the hospital for several days. Most recover within one to two weeks.
Ask the surgeon about what concerns you:
- whether surgery is needed right now;
- whether laparoscopy is possible in your case;
- how long the surgery and anesthesia will take;
- when you will be able to get up and eat;
- when to return to work and sports.
If the pain gradually intensifies or does not go away, and especially if it shifts to the lower right, an urgent examination is needed. This is a reason to call your family doctor or go to the emergency department, not to wait until morning.
Call 103 immediately if the abdominal pain is severe and is accompanied by confusion, pale or mottled skin, or difficulty breathing. These may be signs of sepsis. Do not drive yourself to the emergency department — ask someone to take you or call an ambulance.
This material is for reference and does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer