Appendicitis

Appendicitis typically begins with abdominal pain that starts near the belly button or upper abdomen before shifting to the lower right side. The pain often becomes sharper and constant and may worsen with movement, coughing or sneezing.

Other symptoms of appendicitis include:

• Nausea and vomiting soon after the onset of abdominal pain
• Loss of appetite or difficulty eating
• Low-grade fever as inflammation develops
• Abdominal tenderness, especially on the lower right side
• Bloating or abdominal distension due to inflammation
• Changes in bowel habits, such as mild constipation or diarrhoea

The presentation may vary between individuals. Children, older adults and pregnant patients may not always develop the same symptoms. Persistent or worsening abdominal pain should be assessed by a qualified appendicitis doctor or appendicitis specialist for timely diagnosis.

Appendicitis occurs when the appendix becomes blocked, leading to swelling, bacterial infection and inflammation. The blockage prevents normal drainage of mucus and allows bacteria to multiply within the appendix. As pressure builds, the wall of the appendix may weaken and eventually rupture if not treated in time.

Common Causes of Appendicitis

Several conditions may lead to obstruction or infection within the appendix:

• Hard stool (faecolith): A small, hardened piece of stool that blocks the opening of the appendix.
• Swelling of lymphoid tissue: The lymphatic tissue within the appendix may enlarge due to infection or inflammation elsewhere in the intestines.
• Foreign bodies: Rarely, ingested materials such as seeds or parasites can block the appendix.
• Worm infestation: Parasitic worms can obstruct the lumen and trigger inflammation.
• Tumours or growths: Abnormal tissue growths may close off the opening of the appendix.

When the blockage persists, trapped mucus and bacteria cause the appendix to swell, reducing blood flow to the tissue. This can result in tissue death and a ruptured appendix, which may spread infection throughout the abdomen.

You should consult a colorectal surgeon or appendicitis specialist in Singapore if you experience:

• Severe or persistent abdominal pain
• Fever with nausea or vomiting
• Loss of appetite

Early medical evaluation supports timely appendicitis treatment and reduces the risk of rupture or complications.

Diagnosis begins with a medical evaluation that includes a physical examination, laboratory tests and diagnostic imaging to confirm inflammation of the appendix and rule out other possible causes of abdominal pain.

Common methods include:

• Physical Examination: The doctor checks for tenderness and pain over the lower right abdomen. Pain that worsens when pressure is released may suggest irritation of the abdominal lining, often seen in appendicitis.
• Blood Tests: Used to detect signs of infection such as an increased white blood cell count, which may indicate inflammation. Urine tests may also be done to exclude urinary tract or kidney conditions that can cause similar discomfort.
• Imaging Studies:
  • Ultrasound: Helps identify an enlarged or inflamed appendix and can detect fluid buildup or abscess formation. It is often used as a first imaging step, especially for children and pregnant individuals.
  • CT Scan: Provides more detailed imaging to confirm appendicitis, evaluate for abscess, or identify a ruptured appendix.

These assessments help determine whether appendix surgery or other appendicitis treatment options are required and allow timely management to prevent complications.

Appendicitis should be treated immediately as it can lead to serious complications if left untreated. These include:

• Ischemia and Necrosis - Severe swelling in the appendix causes loss of blood supply which eventually leads to tissue death.
• Perforation - A rupture of the appendix wall can allow bacteria, pus and intestinal contents to spill into the abdominal cavity.
• Abscess Formation - The spilled pus can form a localised abscess around the inflamed appendix.
• Peritonitis - This is a life-threatening inflammation of the peritoneum caused by the spread of bacteria from a ruptured appendix.
• Sepsis - This is a severe infection that can spread throughout the body, potentially leading to organ failure or could even be fatal if not treated.