Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

To help diagnose appendicitis, your health care provider will likely take a history of your signs and symptoms and examine your abdomen.

Tests and procedures used to diagnose appendicitis include:

• Physical exam to assess your pain. Your health care provider may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. They may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your provider may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.
• Blood test. This allows your health care provider to check for a high white blood cell count, which may indicate an infection.
• Urine test. They may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.
• Imaging tests. Your provider may also recommend an abdominal X-ray, an abdominal ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for your pain.

Treatment

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.

But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

Lifestyle and home remedies

Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal:

• Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities after surgery.
• Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.
• Call your health care provider if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor.
• Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks.
• Sleep when tired. As your body heals, you may find that you feel sleepier than usual. Take it easy and rest when you need to.
• Discuss returning to work or school with your health care provider. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports.

Alternative medicine

Your health care provider will prescribe medications to help you control your pain after your appendectomy. Some complementary and alternative treatments, when used with your medications, can help control pain. Ask your provider about safe options, such as:

• Distracting activities, such as listening to music and talking with friends, that take your mind off your pain. Distraction can be especially effective with children.
• Guided imagery, such as closing your eyes and thinking about a favorite place.

Learn more about appendicitis and appendectomies.

This article is written by Mayo Clinic Staff. Find more health and medical information on mayoclinic.org.

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On the next Mayo Clinic Radio program, Dr. Peter Rose, division chair of Orthopedic Oncology at Mayo Clinic, will discuss tumors of the musculoskeletal system. Also on the program, Dr. Leo Maguire, a Mayo Clinic ophthalmologist, will explain how laser-assisted in situ keratomileusis (LASIK) eye surgery can correct common vision problems. And Dr. Erica Loomis, a Mayo Clinic trauma and critical care specialist, will discuss treatment for appendicitis.

Here's your Mayo Clinic Radio podcast.

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Tumors of the musculoskeletal system can originate in bone or soft tissues, such as muscle and cartilage. Both benign and malignant tumors can arise from any soft tissue, such as muscle, or any bones of the arms, legs, pelvis, shoulder or trunk. If the tumors are malignant, meaning they are cancerous, they are called "sarcomas." Compared to tumors at other sites, such as the breast, prostate, kidney or lung, tumors of the bones and soft tissues are relatively rare. Musculoskeletal tumors are diagnosed with imaging and sometimes a biopsy of the tissue. Treatment for cancerous tumors can involve surgery, radiation and chemotherapy.

On the next Mayo Clinic Radio program, Dr. Peter Rose, division chair of Orthopedic Oncology at Mayo Clinic, will discuss tumors of the musculoskeletal system. Also on the program, Dr. Leo Maguire, a Mayo Clinic ophthalmologist, will explain how laser-assisted in situ keratomileusis (LASIK) eye surgery can correct common vision problems. And Dr. Erica Loomis, a Mayo Clinic trauma and critical care specialist, will discuss treatment for appendicitis.

The post Mayo Clinic Radio: Musculoskeletal tumors appeared first on Mayo Clinic News Network.

Tumors of the musculoskeletal system can originate in bone or soft tissues, such as muscle and cartilage. Both benign and malignant tumors can arise from any soft tissue, such as muscle, or any bones of the arms, legs, pelvis, shoulder or trunk. If the tumors are malignant, meaning they are cancerous, they are called "sarcomas." Compared to tumors at other sites, such as the breast, prostate, kidney or lung, tumors of the bones and soft tissues are relatively rare. Musculoskeletal tumors are diagnosed with imaging and sometimes a biopsy of the tissue. Treatment for cancerous tumors can involve surgery, radiation and chemotherapy.

On the next Mayo Clinic Radio program, Dr. Peter Rose, division chair of Orthopedic Oncology at Mayo Clinic, will discuss tumors of the musculoskeletal system. Also on the program, Dr. Leo Maguire, a Mayo Clinic ophthalmologist, will explain how laser-assisted in situ keratomileusis (LASIK) eye surgery can correct common vision problems. And Dr. Erica Loomis, a Mayo Clinic trauma and critical care specialist, will discuss treatment for appendicitis.

The post Mayo Clinic Radio: Musculoskeletal tumors / LASIK surgery / appendicitis appeared first on Mayo Clinic News Network.

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Are antibiotics a safe and effective alternative to surgery for some kids with appendicitis? A recent study published in JAMA Surgery suggests when chosen by the family, nonoperative management is an effective treatment strategy for children with uncomplicated acute appendicitis. We asked Mayo Clinic Children's Center pediatric surgeon Dr. Dean Potter to help us understand the research and its significance.

"The study design is patient choice cohort study, thus after discussing both therapeutic options with the patient and family, the choice was given to the family and patient," says Dr. Potter. "This was not a randomized study."

About the study

Dr. Potter says this latest prospective study investigates the use of antibiotics versus appendectomy for the treatment of acute, uncomplicated appendicitis. "This study found that for a specific subset of patients with appendicitis, antibiotic therapy alone was effective for the treatment of appendicitis. This study excluded a large number of patients including complicated (perforated) appendicitis, young patients (under 7 years of age), presence of appendicoliths, white blood cell count above 18,000 leukocytes, abdominal pain longer than 48 hours, and elevated CRP. Only about 1 out of 6 patients they evaluated met the criteria for the study. With that said, for this specific group of children, antibiotics allowed 94.6 percent to avoid appendectomy during the initial hospital stay, 89 percent for the first 30 days, and 75.7 percent for 21 months following admission."

What it means to patients

It's important to recognize researchers worked with a very select group of patients, and their findings should not be generalized to all patients with appendicitis, points out Dr. Potter. He adds, "Additionally, long-term follow up is lacking, we do not know how many will have recurrent appendicitis in the next five or 10 years. Several secondary outcomes were used to support the nonoperative management of appendicitis. Cost and disability days significantly favored antibiotics over surgery. However, these outcomes maybe affected by recurrent bouts of appendicitis over time."

What parents and caregivers should know

"Parents should be aware that antibiotics alone maybe an option if your child is diagnosed with acute, uncomplicated appendicitis. However, the vast majority of children still require operative management of appendicitis currently. Discussion with a pediatric surgeon is the best way to understand the options that are available for your child." Dr. Potter adds, "Further evaluation of this topic is required before antibiotic therapy becomes standard of care."

About appendicitis

Appendicitis is the most common acute surgical disease in children, with more than 70,000 children diagnosed in the United States each year. Currently, treatment is dependent on the whether the disease is complicated or uncomplicated. Urgent (within 12 hours of observation) laparoscopic appendectomy is the standard of care for uncomplicated appendicitis. Complicated appendicitis may be treated with urgent laparoscopic appendectomy or delayed appendectomy depending on the presence of intra-abdominal phlegmon or abscess. Read more on the symptoms of appendicitis and when to seek medical attention.

The post Mayo Expert on Pediatric Appendicitis Treatment appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Implementation of an algorithm aimed to diagnose pediatric patients with suspected appendicitis reduces the utilization of computed tomography (CT) scans, without affecting diagnostic accuracy, Mayo Clinic Children's Center researchers have found. The study was recently published in the journal Surgery.

Acute appendicitis is the most common cause of acute abdominal pain in children. Appendicitis occurs when the appendix becomes inflamed and filled with pus. CT scans are often used to diagnose acute appendicitis because they are accurate, widely available and have the ability to provide clinicians with advanced information in appendicitis cases suspected of complications.

MEDIA CONTACT: Kelley Luckstein, Mayo Clinic Public Affairs,
507-284-5005, newsbureau@mayo.edu

However, CT scans are expensive and expose patients to ionizing radiation. “This algorithm was developed by a multidisciplinary group of pediatric emergency room physicians, pediatric surgeons and radiologists to eliminate unnecessary exposure to radiation,” explains Michael B. Ishitani, M.D., lead author of the study.

The study compared pediatric patients, under the age of 18, who underwent an appendectomy for acute appendicitis pre-algorithm implementation and post-implementation. Researchers studied 331 pediatric cases over the course of five years, and found that CT utilization decreased from 39 percent to 18 percent after the algorithm was in place.

Researchers found that when the algorithm was implemented, use of CT scans in patients dropped by over 50 percent, without affecting diagnostic accuracy, proving that reducing the use of CT scans when evaluating patients for appendicitis is safe and cost-effective.

“Implementation of this algorithm across multiple centers is the ideal outcome of this study, followed by further evaluations over time to ensure that the low rate of CT scan use continues,” says Dr. Ishitani.

Other study authors include Stephanie F. Polites, M.D., and scholar, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mohamed I. Mohamed, M.B.B.S.; Elizabeth B. Habermann, Ph.D., and scientific director of the Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; James L. Homme, M.D.; Jana L. Anderson, M.D.; Christopher R. Moir, M.D. and Abdalla E. Zarroug, M.D., all of Mayo Clinic.

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