Acute Appendicitis

What is Acute Appendicitis?

Acute appendicitis is a medical condition characterised by the inflammation of the appendix, a finger-shaped pouch projecting from the colon on the lower right side of the abdomen. This condition is considered a medical emergency due to the risk of the appendix rupturing, which can lead to more severe complications such as peritonitis and sepsis if not treated promptly. 

Acute appendicitis typically manifests suddenly, often within 24 hours from the onset of symptoms.

Common causes of Acute Appendicitis in Singapore?

Acute appendicitis is primarily caused by a blockage of the lumen of the appendix. This obstruction can lead to an infection as bacteria multiply. The body's response to this infection causes inflammation and swelling, leading to symptoms of acute appendicitis.

The reasons behind the blockage vary and can include:

• Accumulation of faecal matter: faecoliths (hardened pieces of stool) can cause obstruction. This is the most common cause of appendicitis.
• Enlarged lymphoid follicles: in response to infection elsewhere in the body, the lymphoid follicles within the appendix can become enlarged, leading to blockage.
• Foreign bodies: in rare cases, ingested objects can lodge in the appendix, causing an obstruction.
• Intestinal worms: in some cases, parasitic infections can lead to appendicitis due to blockage by worms.
• Tumours: although less common, tumours can obstruct the appendix. 

What are the symptoms of Acute Appendicitis?

The symptoms of acute appendicitis include:

• Pain in the right side of the lower abdomen
• Loss of appetite
• Pain when coughing, walking, or other jarring movements
• Nausea and vomiting
• Constipation or diarrhoea
• High temperature and a flushed face
• Tenderness in the abdomen

Is Acute Appendicitis painful?

Yes, acute appendicitis is typically painful. The pain starts around your belly button or upper abdomen and shifts to the lower right side of your abdomen. The pain can vary in intensity but becomes sharper and more severe as the condition progresses. The initial discomfort usually starts as a dull ache or may be described as a feeling of indigestion, progressively becoming sharper and more intense. When the pain becomes too much to bear, seek medical attention as soon as possible to prevent complications such as peritonitis.

Who is at risk of Acute Appendicitis in Singapore?

The risk of developing acute appendicitis impacts individuals across various age groups, but several factors have been identified that may raise the likelihood of developing this condition. 

Risk factors of acute appendicitis include:

• Genetics: if you have a family history of appendicitis, you may be at a higher risk of developing it.
• Age: while appendicitis can occur at any age, it is most common among individuals aged 10 to 30.
• Obstruction and infections: an appendix obstruction, caused by hardened stool, swollen lymph nodes, or growths, can lead to infection as bacteria multiply, potentially causing appendicitis.
• Gastrointestinal infections: bacterial, viral, or parasitic infections in the digestive system may spread to the appendix.
• Inflammatory bowel disease: conditions such as Crohn's disease may heighten your risk of acute appendicitis.
• Environmental factors: some studies propose that lifestyle and environmental factors, such as air pollution, could be linked to an increased risk of acute appendicitis.
• Dietary factors: a low-fibre, high-refined sugar diet might contribute to the risk, though ongoing research is exploring this.
• Specific symptoms and conditions: symptoms such as epigastric pain, diarrhoea, or malaise have been noted as risk factors for complicated appendicitis.

It is vital to recognise that while these factors can heighten the risk of appendicitis, the condition can still develop without clear risk factors. If you suspect symptoms of appendicitis in yourself or someone else, seek immediate medical attention.

How is Acute Appendicitis diagnosed in Singapore?

Acute appendicitis is diagnosed through your medical history, physical examinations, laboratory tests, and/or imaging studies.

Diagnosis of acute appendicitis occurs as follows:

• Medical history and symptoms: your specialist will start by asking about your symptoms and reviewing your medical history.
• Physical examination: a physical exam will be conducted to assess your abdomen. Gentle pressure may be applied to the area you are experiencing pain. When the pressure is suddenly released, the pain will often feel worse, indicating the presence of peritoneal irritation (known as rebound tenderness).
• Laboratory tests: blood tests may be used to check for signs of infection, such as high white blood cell count. Alternatively, urine tests can help to rule out urinary tract infections or kidney stones that can cause similar symptoms to acute appendicitis.
• Imaging tests: imaging studies help to confirm the diagnosis of appendicitis.
  • Ultrasound: an ultrasound is often the first imaging test done for pregnant women in their first trimester.
  • CT (computed tomography) scan: a CT scan provides detailed images of the appendix and can show if it is swollen or has an abscess. CT scans are highly effective in diagnosing appendicitis in children and adults. This is the most common imaging performed to diagnose appendicitis.
  • MRI (magnetic resonance imaging) scan: MRI scans are used to reduce radiation exposure in some instances, such as during pregnancy (from the second trimester onwards).
• Observation: in some cases where the diagnosis is unclear but there are no alarming symptoms, your doctor may recommend an observation period. This can include a hospital stay for monitoring, repeated examinations, and/or further tests to help clarify the diagnosis.

What are the treatment options for Acute Appendicitis in Singapore?

The treatment options for acute appendicitis in Singapore primarily include:

• Surgical intervention: the most common and traditional form of treatment is an appendectomy, the surgical removal of the appendix. Laparoscopic appendectomy (LA), using the key-hole method, has been identified as the most effective surgical treatment, offering advantages such as a lower incidence of postoperative complications compared to open surgery. Very rarely, if the appendicitis is severe or ruptured, open surgery may be required. 

Frequently asked questions

Can acute appendicitis heal on its own?

No, acute appendicitis typically requires treatment. If left untreated, your appendix may rupture and lead to severe complications.

Can children get acute appendicitis?

Yes, children are susceptible to acute appendicitis, a common cause of emergency abdominal surgery in this age group. Symptoms in children may resemble those in adults, but younger children may find it challenging to articulate their discomfort.

Is there a difference in symptoms between adults and children?

While the core symptoms of appendicitis (abdominal pain, nausea and/or fever) are consistent across age groups, young children and toddlers may struggle to describe their pain or display less specific symptoms such as a swollen belly, vomiting and irritability.