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Appendicitis

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis and Possible Complications
• Following Up
• Supporting Research

Appendicitis is an inflammation of the appendix that is usually caused by an obstruction, but may be caused by an infection. The appendix is a small finger-shaped structure that protrudes from the large intestine and hangs down on the lower right side of the abdominal cavity. If untreated, an inflamed appendix can rupture, causing infection of the peritoneal cavity (the lining surrounding the abdominal organs) and even death. Appendicitis is one of the most common causes of emergency abdominal surgery. Up to 75,000 such surgeries are performed each year in the U.S.

Signs and Symptoms

Appendicitis is accompanied by the following signs and symptoms:

• The main symptom is pain, beginning around the navel, then moving down and to the right side of the abdomen. The pain worsens when moving, taking deep breaths, coughing, sneezing, or being touched in this area.
• Loss of appetite
• Nausea
• Vomiting
• Change in bowel movements, including diarrhea or inability to have a bowel movement or pass gas
• Low fever that begins after other symptoms
• Urinating frequently, or difficult or painful urination

What Causes It?

Appendicitis usually occurs following an infection in the digestive tract, or when the tube connecting the large intestine and appendix is blocked by trapped feces or food. The resulting inflammation can lead to infection or rupture of the appendix.

Who's Most At Risk?

The following factors can put you at higher risk for developing appendicitis:

• Family history
• Children 2 years of age or younger and people 70 years of age or older are at higher risk for a ruptured appendix

What to Expect at Your Provider's Office

Because of the risk of rupture, appendicitis is considered an emergency. If you are experiencing symptoms of appendicitis, you should go to an emergency room. The doctor will ask about your symptoms and your medical history, conduct a physical exam to check for abdominal tenderness, and may order blood tests and urine tests. Some health care providers use ultrasound to check whether the appendix is inflamed (and to rule out ovarian cysts or ectopic pregnancy in women). A computed tomography (CT) scan may also be performed.

Treatment Options

Prevention

There is no proven way to prevent appendicitis, but eating a diet that includes fresh vegetables and fruit may decrease the likelihood of developing the condition.

Treatment Plan

Appendicitis is most often treated with a combination of surgery and antibiotics. In addition to antibiotics, you will receive intravenous fluids and possibly medication to control vomiting. Exploratory surgery is performed if the doctor is not able to determine from the CT scan or ultrasound whether you have appendicitis, or when the diagnosis from tests such as an ultrasound or CT scan is not clear. If appendicitis is confirmed, either from tests or exploratory surgery, the appendix is removed (appendectomy).

Drug Therapies

Your health care provider may prescribe the following medications:

• Antibiotics
• Medications taken to ease nausea

Surgical and Other Procedures

An appendectomy is the surgical removal of the appendix through an incision in your abdomen that can be several inches long. A laparoscopic appendectomy involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. The surgeon then removes the appendix through one of the small incisions. Recovery is usually faster than with traditional surgery, and the scars are smaller. However, not everyone is a candidate for the laparoscopic procedure.

Complementary and Alternative Therapies

Acute appendicitis is a medical emergency, so you should seek conventional treatment immediately. Never try to treat appendicitis with alternative therapies. Some studies show that certain herbs and supplements may help to prevent appendicitis, strengthen your immune system, or help you recover faster from surgery.

Nutrition

In England and Wales, a study reviewed whether low intake of fiber and high intake of sugar and meat influenced the development of acute appendicitis. The study evaluated the dietary habits of 49,690 patients diagnosed with acute appendicitis. Although no specific link was found with sugar or meat, the study did suggest that the more fresh and frozen green vegetables and fresh and processed tomatoes people ate, the less likely they were to develop appendicitis. Eating green vegetables -- particularly cabbages, cauliflowers, peas, beans, and Brussels sprouts -- and possibly tomatoes may protect against appendicitis.

If you need an appendectomy, the following supplements may help you recover faster:

• Beta-carotene (250,000 IU a day) or vitamin A (25,000 IU a day) to promote healthy scar tissue. These are high doses and should not be taken for longer than 1 - 2 weeks without your health care provider's supervision. Reduce dose to 50,000 IU of beta-carotene and 15,000 - 25,000 IU of vitamin A daily after 2 weeks. Do not take vitamin A if you are pregnant or trying to conceive, or if you have a history of liver disease.
• Vitamin C (1,000 mg two to six times per day) helps skin heal and strengthens the immune system. Lower dose if diarrhea develops.
• Vitamin E (400 - 800 IU a day) and zinc (10 - 30 mg per day) promote healing.
• Bromelain (40 mg four times a day between meals) reduces post-surgical swelling, bruising, healing time, and pain.
• L-arginine (17 - 25 g per day) has been used to improve healing time in surgery patients. Some anecdotal reports link high arginine doses with an increase in herpes outbreaks in those people previously infected with the herpes virus, so you may want to talk to your doctor before taking arginine.

Herbs

Traditional Chinese herbal therapies may help treat appendicitis. There is not yet enough scientific research on Chinese or Western herbs to say that traditional Chinese medicine (TCM) is effective for appendicitis, but there are some case reports from a TCM perspective. In a report of 425 patients with acute appendicitis treated with Chinese herbal preparations, either with or without antibiotics, the majority did well and did not require surgery. Only 30 patients had acute relapse of appendicitis shortly after recovery. However, because standards of care vary between different TCM practitioners, appendicitis should be treated by conventional medicine and not with acupuncture and Chinese medicine.

Other herbs that may help your body recover faster if you have appendectomy include:

• Gotu kola ( Centella asiatica) -- promotes connective tissue repair, supports normal wound healing, and prevents a scar from growing larger. Use standardized extract 60 mg one to two times daily, or 60 drops of tincture three to four times per day. Do not take gotu kola if you have high blood pressure or anxiety.
• Dandelion ( Taraxacum officinale , 2 - 8 g per day) -- has anti-inflammatory and antioxidant properties. Be sure you do not have an allergy to dandelion, and avoid taking the herb if you have liver or gallbladder disease, diabetes, or kidney disease, or if you take blood-thinning medication.
• Agrimony (Agrimonia eupatoria) has been used historically for appendicitis. Make a tea by steeping 1 tsp. of the herb in one cup boiling water, strain, and cool. Drink every 2 - 3 hours. Do not take agrimony if you take medication for blood pressure or blood-thinning medication, or if you have diabetes.

Homeopathy

Using the appropriate homeopathic remedy along with conventional Western medicine may relieve your symptoms and help clear up appendicitis more quickly. However, no scientific literature supports the use of homeopathy for appendicitis. An experienced homeopath would consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms. Belladonna and Bryonia are classic homeopathic remedies often used for an inflamed appendix.

Acupuncture

In Chinese medical terms, appendicitis is thought to be caused by blockages in the circulation of blood and flow of vitality. Acupuncture appears to help relieve pain, control peristalsis (the wave-like movements of muscles in the intestines), and improve blood flow. Case reports from China suggest that acupuncture has been used for mild appendicitis. Electroacupuncture (sending electric current through needles) has also been used.

A licensed and certified acupuncturist would work together with your doctor to monitor your condition closely. In some parts of the world, an acupuncturist works in the hospital to deliver care at the same time as conventional medical practices. Even with surgery, acupuncture can be quite useful for anesthesia, pain control, and improved recovery.

Massage

You should not have a massage during an attack of appendicitis.

Prognosis and Possible Complications

In cases without rupture, the risk of death is very low. In cases where the appendix ruptures, the mortality rate is higher, and is especially high among the elderly (15%). Complications may include recurring appendicitis, inflammation of the abdominal lining, abscess (pus-filled inflamed area), sepsis (poisoning caused by the presence of infectious bacteria in the blood), obstruction of a fallopian tube, infertility, and wound infection. Appendicitis occurs in only about 1 in 1000 pregnancies.

Following Up

If you have surgery, you will need to see your provider 2 weeks after the operation, and again at 6 weeks.

Supporting Research

Barker DJ, Morris J, Nelson M. Vegetable consumption and acute appendicitis in 59 areas in England and Wales. Br Med J (Clin Res Ed) . 1986;292(6525):927-930.

Behrman RE, ed. Nelson Textbook of Pediatrics . 15th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine . 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Dambro MR. Griffith's 5 Minute Clinical Consult . Baltimore, Md: Lippincott Williams & Wilkins; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: McGraw-Hill; 1998.

Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 6th ed. Philadelphia, Pa: W.B. Saunders Co; 1998.

Fan YK, Zhang CC. 20 years' acupuncture in 461 acute appendicitis cases. Chin Med J (Engl) . 1983;96(7):491-494.

Garcia Peña BM, Mandl KD, Kraus SJ, et al. Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA . 1999;282(11):1041-1046.

Hull J. Iontophoresis. Physical Therapy Procedures III course handout, 1997. North Central State College. Mansfield, Ohio. Accessed on September 18, 2000.

Longmire WP Jr. Invited commentary. World J Surg . 1979;3(1):130-132.

McKinney PE. Elemental mercury in the appendix: an unusual complication of a Mexican-American folk remedy. J Toxicol Clin Toxicol . 1999;37(1):103-107.

No author listed Combined traditional Chinese and Western medicine in acute appendicitis. Chin Med J (Engl). 1977;3(4):266-269.

Treatment of acute appendicitis in children with combined traditional Chinese and Western medicine. Chin Med J (Engl). 1977;3(6):373-378.

Pisacane A, de Luca U, Impagliazzo N, Russo M, De Caprio C, Caracciolo G. Breast feeding and acute appendicitis. BMJ . 1995;310(6983):836-837.

Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med . 1998;338(3):141-146.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Management . 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Sabiston DC, Lyerly HK, eds. Textbook of Surgery . 15th ed. Philadelphia, Pa: W.B. Saunders Co; 1998.

Wu HC. Treatment of acute abdominal diseases by combined traditional Chinese and Western medicine. World J Surg. 1979;3(1):91-94.

Zheng XL, Chen C, Wu XZ. Acupuncture therapy in acute abdomen. Am J Chin Med . 1985;13(1-4):127-131.

• Review Date: 10/23/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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