Appendicitis in Adults: Causes, Diagnosis and Treatment
Appendicitis in adults is inflammation of the appendix, usually caused by a blockage inside it, and it typically produces pain that starts around the navel and settles in the lower right abdomen, along with loss of appetite, nausea and fever. It is diagnosed through a physical examination, blood tests and imaging such as a CT scan or ultrasound. Most adults are treated with surgical removal of the appendix (appendectomy), often by laparoscopic keyhole surgery. Because an inflamed appendix can burst, suspected appendicitis needs same-day medical attention.
This guide explains why appendicitis develops in adults, how surgeons confirm the diagnosis and what treatment and recovery involve.
What Is the Appendix?
The appendix is a small, finger-like tube attached to the first part of the large intestine (the caecum) in the lower right abdomen. It contains lymphoid tissue, but people can live normally without it. When it becomes blocked and infected, it causes appendicitis.
What Causes Appendicitis in Adults?
Appendicitis usually begins with a blockage of the appendix opening. Mucus builds up, pressure rises, bacteria multiply and the wall becomes inflamed. Common causes of the blockage include:
- Faecolith: a small, hard piece of stool trapped in the appendix
- Lymphoid swelling: enlargement of lymph tissue, sometimes after an infection
- Foreign material or parasites: uncommon causes
- Growths: in older adults, a tumour of the appendix or large bowel can occasionally block the opening
Appendicitis can affect anyone. It is most common between the ages of 10 and 30, but it also occurs in older adults, in whom it is sometimes diagnosed later because symptoms are less typical.
Symptoms of Appendicitis in Adults
- Dull pain near the navel that moves to the lower right abdomen over several hours
- Pain that worsens with coughing, walking or going over bumps
- Loss of appetite
- Nausea and vomiting
- Low-grade fever
- Constipation, diarrhoea or bloating
Atypical symptoms
In pregnant women, the pain may be higher in the abdomen. In older adults and people with diabetes, pain may be mild and fever absent. If the appendix lies behind the bowel or in the pelvis, pain may be felt in the back, flank or while passing urine. For more on this, read unexpected symptoms of appendicitis.
Emergency warning signs
Go to an emergency department immediately if pain becomes severe or spreads across the whole abdomen, if the abdomen becomes rigid, or if you have high fever, persistent vomiting, a fast heart rate or feel faint. These may signal a burst appendix.
How Is Appendicitis Diagnosed?
Clinical examination
The surgeon asks about how the pain started and how it has changed, then examines the abdomen for tenderness, guarding and specific signs, such as pain in the lower right abdomen when the left side is pressed.
Blood and urine tests
A raised white blood cell count and C-reactive protein (CRP) support infection or inflammation. A urine test helps rule out urinary infection or kidney stones. Women of childbearing age usually have a pregnancy test.
Imaging
- CT scan: commonly used in adults to confirm appendicitis and look for complications such as an abscess
- Ultrasound: useful in younger, slimmer patients and in pregnancy
- MRI: an option in pregnancy when ultrasound is unclear
Conditions that can look similar
Gastroenteritis, kidney stones, urinary infection, ovarian cysts, ectopic pregnancy, pelvic infection, inflammation of the bowel and diverticulitis can all mimic appendicitis. Careful evaluation helps tell them apart.
Treatment of Appendicitis in Adults
Initial care
Once appendicitis is suspected, you are usually asked not to eat or drink. Intravenous fluids, antibiotics and pain relief are started.
Laparoscopic appendectomy
In laparoscopic (keyhole) surgery, the surgeon makes a few small incisions and uses a camera and fine instruments to remove the appendix. The approach also allows the surgeon to inspect other abdominal organs. Smaller incisions are generally associated with less wound pain and a quicker return to routine activities compared with open surgery. You can read more about keyhole surgery.
Robotic-assisted surgery
In selected cases, the surgery may be done with robotic assistance, where the surgeon controls the instruments from a console. The suitability of this approach depends on the case and is discussed in advance.
Open appendectomy
An open operation through a single incision in the lower right abdomen may be preferred in some situations, such as a large abscess or difficult anatomy.
Antibiotics alone
For some adults with uncomplicated appendicitis, a course of antibiotics without surgery may be discussed. The appendicitis can return in some people, so the surgeon will explain the benefits and limits.
Complicated appendicitis
If the appendix has burst or formed an abscess, treatment may include longer antibiotics, drainage of the abscess and surgery either at once or after the infection settles.
Recovery After Appendix Surgery
- Walking is encouraged from the day after surgery, or sooner
- Diet is restarted gradually as advised
- Keep the wounds clean and dry and attend the dressing review
- Avoid heavy lifting and strenuous exercise for the period your surgeon recommends
- Report fever, increasing pain, vomiting or wound redness promptly
Our guide on dos and don’ts after appendix surgery has more tips.
Frequently Asked Questions
What is the main cause of appendicitis in adults?
Appendicitis usually starts when the opening of the appendix is blocked, often by hardened stool (a faecolith), swollen lymph tissue or, less commonly, a growth. Bacteria then multiply inside the blocked appendix, causing inflammation and infection.
Where is appendix pain felt in adults?
Pain typically begins around the belly button and moves over several hours to the lower right abdomen. In some people, such as pregnant women or those whose appendix lies in an unusual position, the pain may be felt higher, in the back or in the pelvis.
Which test confirms appendicitis?
No single test is perfect. Doctors combine examination findings with blood tests and imaging. A CT scan of the abdomen is commonly used in adults, while ultrasound or MRI may be preferred in pregnancy.
Can appendicitis be treated with antibiotics instead of surgery?
Some adults with uncomplicated appendicitis confirmed on a CT scan may be offered antibiotics alone after discussion with the surgeon. There is a chance of the appendicitis returning, and surgery remains the standard approach for most people.
How long is recovery after laparoscopic appendectomy?
After uncomplicated keyhole surgery, many adults go home within one to two days and return to desk work within one to two weeks. Heavy lifting is usually avoided for a few weeks. A burst appendix needs a longer recovery.
What happens if appendicitis is not treated?
An untreated inflamed appendix can burst, spreading infection in the abdomen (peritonitis) or forming an abscess. These complications are serious and need urgent treatment.
Consult Dr. Abhijit Gotkhinde in Pune
If you have abdominal pain that you are unsure about, timely evaluation helps avoid complications. Dr. Abhijit Gotkhinde (MBBS, DNB Surgery, FMAS, FIAGES, FALS Robotics) is a robotic, laparoscopic and laser surgeon in Pune. Learn more about appendix treatment in Pune.
- Fatima Nagar: A Wing, 1st floor, Parmar Plaza, Fatima Nagar, Wanowrie, Pune 411040. Phone: +91 88015 10151. OPD 11 AM to 1:30 PM, daily except Sunday
- Hadapsar: Office no. 8, Aaru Palace, near Shitala Devi Mandir, Subhash Nagar, Chaitanya Colony, Hadapsar, Pune 411028. Phone: +91 91751 75065. 5:00 PM to 6:30 PM (by appointment) and 8 PM to 9 PM
To book a visit, use the contact page. For severe pain, go to the nearest emergency department.
