The appendix is a small, finger-shaped organ connected to the large intestine, typically located in the lower right abdomen. This narrow, tube-like pouch protrudes from the cecum. Its exact function is not fully understood, but it is recognized for its potential to become inflamed.
Normal and Concerning Appendix Dimensions
A typical appendix averages 8 to 10 centimeters in length and 7 to 8 millimeters in diameter. On medical imaging like ultrasound, a normal appendix generally appears as a compressible tubular structure with a maximal outer diameter not exceeding 6 millimeters. However, appendicitis diagnosis is not based on size alone; a normal appendix can measure larger than 6 millimeters, particularly on CT scans (some studies show up to 12.8 mm). An inflamed appendix typically shows a diameter greater than 6 millimeters on both ultrasound and CT scans, along with other signs of inflammation.
The Path to Appendiceal Danger
Inflammation of the appendix, known as appendicitis, commonly begins with a blockage of the appendiceal lumen. This blockage is often caused by hardened stool (fecalith), foreign bodies, or swollen lymphoid tissue. This obstruction traps mucus and bacteria, leading to a buildup of pressure within the appendix. The increased pressure restricts blood flow to the appendix wall, causing tissue damage and allowing bacteria to multiply.
If left untreated, the inflammation progresses, potentially leading to severe complications. The appendix wall can weaken and develop holes, or even rupture entirely, spilling infected contents into the abdominal cavity. This can result in peritonitis, a serious infection of the abdominal lining, or the formation of an abscess, which is a localized pocket of pus. These complications can spread infection throughout the bloodstream, potentially leading to sepsis, a life-threatening condition.
Signs and Diagnosis of Appendicitis
The symptoms of appendicitis often begin with abdominal pain that starts around the navel and then shifts to the lower right side of the abdomen, becoming more focused and severe. This pain can worsen with movement, coughing, or sudden jarring. Other common symptoms include nausea, vomiting, loss of appetite, and a low-grade fever. Some individuals may also experience constipation or diarrhea.
Diagnosis involves physical examination, laboratory tests, and imaging. During a physical exam, tenderness in the lower right abdomen, particularly at McBurney’s point, is a common finding. Blood tests may show an elevated white blood cell count, indicating an infection. Imaging tests, such as ultrasound or computed tomography (CT) scans, are frequently used to confirm the diagnosis and visualize the inflamed appendix. Ultrasound is often preferred for children and pregnant women due to its lack of radiation exposure.
Managing an Inflamed Appendix
The standard approach involves surgical removal of the appendix, a procedure known as an appendectomy. This surgery can be performed using either an open method, which involves a single larger incision in the lower right abdomen, or a laparoscopic method. Laparoscopic appendectomy is a less invasive technique that uses several small incisions, a camera, and specialized tools, often resulting in faster recovery and less pain.
In cases where the appendix has ruptured and an abscess has formed, the abscess may be drained before the appendix is surgically removed. While surgery is the primary treatment, some uncomplicated cases of appendicitis may be managed with antibiotics alone, especially if there are no signs of rupture or abscess formation. However, even with antibiotic treatment, there is a possibility of recurrence, and surgery remains the definitive solution for appendicitis.