Appendicitis

Appendicitis is inflammation of the appendix — a small, finger-shaped pouch attached to the large intestine in the lower right abdomen. It is the most common cause of acute surgical abdominal emergency in Nigeria and worldwide. When the appendix becomes blocked and inflamed, it can fill with pus. If not treated promptly, the appendix can burst (perforate), spilling infection into the abdominal cavity and causing a life-threatening condition called peritonitis. Appendicitis can occur at any age but is most common between the ages of 10 and 30. Surgery to remove the appendix (appendectomy) is the standard treatment.

Appendicitis classically presents in a characteristic sequence: • Pain that begins around the navel (umbilicus) and shifts to the lower right abdomen over 12–24 hours: the classic migration of pain • The pain becomes progressively more severe and constant • Loss of appetite • Nausea and vomiting (usually after the pain begins) • Low-grade fever (37.5–38.5°C), which may rise if the appendix perforates • Inability to pass gas or bowel movements • Abdominal rigidity: the abdominal muscles tighten • Pain that worsens with movement, coughing, or deep breathing Not all cases are typical: • In young children, symptoms may be hard to localise and diagnosis is more difficult • In pregnancy, the appendix shifts upward, so pain may be higher than expected • In the elderly, symptoms may be milder and perforation occurs more quickly • Some patients have their appendix in an unusual position, causing pain elsewhere

Appendicitis occurs when the appendix becomes obstructed and inflamed. The obstruction is usually caused by: • Hardened stool (faecoliths or appendicoliths): the most common cause in adults • Mucus build-up within the appendix • Enlarged lymph nodes in the intestinal wall (often following gastrointestinal infection or viral illness): more common in children • Intestinal parasites: in regions with high parasite burden • Rarely: tumours or foreign bodies Once obstructed, bacteria inside the appendix multiply rapidly, causing swelling, increased pressure, reduced blood supply, and ultimately tissue death. The appendix can perforate within 48–72 hours, releasing infected contents into the abdomen.

• Age 10–30 years: peak incidence group • Male sex: appendicitis is slightly more common in males • Diet low in fibre: may contribute to constipation and faecal obstruction • Family history of appendicitis • Intestinal infections and gastroenteritis episodes • High intestinal parasite burden (as in some Nigerian communities) Note: appendicitis cannot be reliably prevented. Awareness of symptoms and prompt medical care are the most important protective factors.

• Perforation (rupture of the appendix): occurs in 20–30% of cases overall; rates are higher in children (who have more difficulty describing symptoms) and in settings with limited diagnostic resources • Peritonitis: widespread infection of the abdominal cavity from a ruptured appendix; life-threatening • Abscess: a localised collection of pus in the abdomen after perforation • Sepsis: systemic infection from peritonitis, which can cause multi-organ failure and death • Wound infection and other surgical complications • Death: rare in settings with prompt surgical care, but higher in resource-limited settings where perforation is common at presentation

There are no proven ways to prevent appendicitis. However: • A high-fibre diet (fruits, vegetables, wholegrains, legumes) may reduce the risk of faecal obstruction of the appendix • Prompt treatment of intestinal parasites may reduce the risk in endemic settings • Early recognition and timely surgical care prevent perforation and its serious complications The most important action is recognising the symptoms early and seeking medical care without delay.