Appendix removal

The appendix is a small, finger-shaped organ that comes out from the first part of the large intestine. It is removed when it becomes swollen (inflamed) or infected. An appendix that has a hole in it (perforated) can leak and infect the entire abdomen area, which can be life threatening.

An appendectomy is done using either:

• Spinal anesthesia. Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy.
• General anesthesia. You will be asleep and not feel any pain during the surgery.

The surgeon makes a small cut in the lower right side of your belly area and removes the appendix.

The appendix can also be removed using small surgical cuts and a camera. This is called a laparoscopic appendectomy.

If the appendix broke open or a pocket of infection (abscess) formed, your abdomen will be washed out during surgery. A small tube may be left in the belly area to help drain out fluids or pus.

An appendectomy is done for appendicitis. The condition can be hard to diagnose, especially in children, older people, and women of childbearing age.

Most often, the first symptom is pain around your belly button.

• The pain may be mild at first, but it becomes sharp and severe.
• The pain often moves into your right lower abdomen and becomes more focused in this area.

Other symptoms include:

• Diarrhea or constipation
• Fever (usually not very high)
• Nausea and vomiting
• Reduced appetite

If you have symptoms of appendicitis, seek medical help right away. Do not use heating pads, enemas, laxatives, or other home treatments to try and relieve symptoms.

Your health care provider will examine your abdomen and rectum. Other tests may be done.

• Blood tests, including a white blood cell count (WBC), may be done to check for infection.
• When the diagnosis is not clear, the doctor may order a CT scan or ultrasound to make sure the appendix is the cause of the problem.

There are no actual tests to confirm that you have appendicitis. Other illnesses can cause the same or similar symptoms.

The goal is to remove an infected appendix before it breaks open (ruptures). After reviewing your symptoms and the results of the physical exam and medical tests, your surgeon will decide whether you need surgery.

Even when the surgeon finds that the appendix is not infected, it will be removed to prevent future problems.

Risks from any anesthesia include the following:

• Reactions to medications
• Problems breathing

Risks from any surgery include the following:

• Bleeding
• Infection

Other risks with an appendectomy after a ruptured appendix include the following:

• Buildup of pus, which may need draining and antibiotics
• Longer hospital stays
• Side effects from medications

Patients tend to recover quickly after a simple appendectomy. Most patients leave the hospital in 1 - 2 days after surgery. You can go back to your normal activities within 2 - 4 weeks after leaving the hospital.

Patients who have the appendix removed through small surgical cuts tend to recover and get back to their daily activities faster.

Recovery is slower and more complicated if the appendix has broken open or an abscess has formed.

Living without an appendix causes no known health problems.

Wolfe JM, Henneman PL. Acute appendicitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 91.

Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW; American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55:71-116.