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What Is Perforated Appendicitis?

A perforated appendicitis occurs when the inflamed appendix ruptures.
The surgical procedure used to repair a perforated appendicitis is an appendectomy.
Abdominal pain, fever, and chills are common symptoms of perforated appendicitis.
Appendicitis usually occurs as a result of appendix inflammation.
Symptoms of perforated appendicitis can vary.
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  • Written By: Nat Robinson
  • Edited By: Heather Bailey
  • Last Modified Date: 14 December 2014
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The appendix is a tiny pouch located at the top of the large intestine. Appendicitis usually happens as a result of appendix inflammation. If the pus-filled appendix ruptures, the condition is known as perforated appendicitis. With a ruptured appendix, an individual can become severely ill because contents in the intestines can leak into the abdomen, leading to a possibly life-threatening infection. Due to its severity, perforated appendicitis is treated by removing the appendix as soon as possible.

There are several factors that can contribute to a perforated appendix. Sometimes a gastrointestinal viral infection can lead to this condition. More commonly, an obstruction such as fecal matter can create a blockage in the appendix, which can cause bacteria to spread and inflammation to occur. If the appendix swells to the point where it ruptures or perforates, a periappendiceal abscess may form. This is generally a pocket of infection, that must be drained before the appendix can be removed.

Symptoms of a perforated appendix can vary. Generally, the initial pain may occur around the belly button and spread into the lower right side. The abdomen may become swollen and tender to touch. There may also be fever, chills, nausea, vomiting, diarrhea or constipation. These symptoms in an individual with a perforated appendix will become worse and more severe as times go on, possibly to the point of collapsing.

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It is important to remove a perforated appendix as soon as possible, because a condition known as peritonitis can occur. This is an inflammation of the entire abdominal cavity and happens as a result of intestinal contents entering into the abdomen. If not treated immediately, this condition can lead to death. For this reason, an individual experiencing any symptoms of a possible appendicitis should seek medical help at once to get the appendix removed before it ruptures. A physical examination, blood tests and a diagnostic imaging test will generally be done to give the doctor a detailed perspective on the type of appendicitis present and the extent of damage done to the abdomen.

An appendectomy is the surgical procedure most commonly used to treat perforated appendicitis. This involves the removal of the appendix. The abdominal cavity will also be cleaned of any spilled contents as well. Following the surgery, antibiotics will be prescribed for an extensive amount of time to ensure that all of the infection is removed from the entire abdomen. Typically, an individual with perforated appendicitis may recover a bit slower than an individual without a ruptured appendix, as the surgery is more extensive.

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anon330041
Post 14

@anon275057: Wow! My five year old had almost the same situation! She is getting her picc line removed next week and then has to get her appendix out in about six weeks. That's after spending a week at children's hospital on three types of IV antibiotics and being sent home with the picc line for two weeks! Hope your son is doing better!

anon318451
Post 13

When I was 5 years old, what my mother and doctor thought was the flu turned out to be a very bad case of appendicitis. The worst the doctors had seen, I've been told. It went misdiagnosed for over a week and my mom took me to my doctor and said she can't eat she can't drink, everything I put in her comes back up.

At the time my mother didn't have insurance and didn't want to take me to the hospital unless absolutely necessary. My doctor said he didn't know what it could be, but if I waited any longer I would die. So my mom took me to a hospital that specalized in treating young children. The doctors (five in total) looked at me and my mom described what was wrong with me and they said it was a perforated appendix. They prepared me for emergency surgery and they quickly realized they didn't have the equipment needed to keep me alive during the operation so they transported me to the ICU of another hospital. The hospital there then took it out and cleaned my organs and did not sew me up or close the opening up.

My scar (as we call it) is fully healed and nothing is holding it together. That was 12 years ago.

anon313731
Post 12

My son began having tummy pains and vomiting on Sunday night. Since it was winter and the winter vomiting virus was everywhere, we presumed this is what it was. This continued for two days until he had vomited so regularly, the vomit was alarmingly green in colour and he had uncontrollable diarrhea. I phoned our local doctor's surgery (since he didn't think he could make it in there) and described his symptoms over the phone, and was prescribed dioralyte to replace lost body fluids and an anti-nausea drug. He was in extreme pain most of the time and we controlled it with 8mg codeine, 500mg paracetamol over the counter drugs.

By the following Thursday night, I was really concerned that he was still in so much pain and over the phone the doctor said to continue with small sips of water. When his vomit turned black, we took him to the emergency department at the hospital, although his pain had subsided. Two doctors examined him and thought it was the tummy bug so common at the time. The next day an X-ray showed a blockage in his bowel. He had a camera inserted through his belly button and it turned out to be a burst and very messy appendix. He had his bowel washed out and returned with two drains in his tummy, on a high dose of antibiotics and his bowel is still not working so he can't eat. He has had no food for over a week. I pray he'll make a full recovery. The guilt that I didn't instinctively know it was worse than a tummy bug is eating me up.

anon296605
Post 11

I have suffered from digestive problems for years. I've been diagnosed with a hiatal hernia, reflux and irritable bowel syndrome. Two months ago I went to the ER after having severe abdominal pain for a few days. I put it off as I thought it all had to do with my other issues. It was a perforated appendix. I was put on IV antibiotics for three days and antibiotics at home for two weeks.

I had the appendix removed three weeks ago. I am recovering now and very curious to see if any of my digestive problems are better. I am now wondering if a lot of my problems weren't due to appendicitis. Could this have been going on for months? I had so many vague symptoms -- fatigue and back aches, which I attributed to the lifting I do at work, along with loss of appetite, bloating, etc. Time will tell!

anon293021
Post 10

I just had my perforated appendix out three weeks ago. I had the classic symptoms for only 24 hours. I had been having other symptoms for about a year and a half that have now disappeared! I had very acute hot flashes, stomach pain behind my navel that would come and go, a bloated stomach and I couldn't lose weight. I craved sweets and caffeine, carbs like cereal and bread and milk and I almost stopped eating red meat entirely.

Immediately after having my appendix removed, I began craving beef, I no longer crave caffeine, sweets or cereals. In fact, I am craving water like never before! I have lost six pounds without trying. No more hot flashes, no bloating and no pains.

anon284403
Post 9

I had no nausea or vomiting.I had a normal WBC; RLQ pain that radiated to the umbilicus. It turned out to be a perforated appendicitis. Not everyone follows the norm.

anon275057
Post 8

My son was finally diagnosed with a perforated appendix nearly a week after the first symptoms. We went to the local ER here three separate occasions and each time they felt it was a mere viral infection or flu.

Once arriving at one of the best children's hospitals on the West Coast, it was decided that the appendix was indeed compromised. Rather than surgery or drainage, they opted to treat with antibiotics and surgery in a month to tie off the appendix, or what is left of it. The general thoughts at present are that you are better off going this route than opening up the cavity and creating more infection.

He has a PICC line being put in place today followed by a heavy regimen of antibiotics.

There are many ways to treat the same condition.

anon256369
Post 5

I had my perforated appendix removed almost six months ago. My symptoms leading up to diagnosis were that my abdomen was bloated, warm to the touch and I had unusual pain (I described as poison running through my abdomen) centered above my belly button and a low grade fever. This was 48 hours prior to going to the emergency room because the pain worsened to the point of being unable to stand up straight, vomiting, diarrhea and being unable to eat anything.

I was diagnosed via blood tests which showed an elevated white blood cell count (infection) and CT scan which shows that I had appendicitis. The pain I felt (two days before going to the ER) was unlike anything I ever felt before. It was not comparable to food poisoning or a virus. Do not hesitate if you have these symptoms. I spent nine days in the hospital to treat the infection and to drain the abscess I developed.

anon217129
Post 4

I just had mine removed. I can tell you that I had bloating before and a weird sensation, not so much pain in the abdomen. I felt most of my pain in my back. went to an emergency room on a Friday and they treated me for back pain and sent me home. Monday they ct scanned me and called me to go to the ER.

An appendix can disguise itself as many things. One clue would be an elevated white count. I am concerned that the surgeon, whom I met only before surgery, did not prescribe any antibiotics after he told my wife I had a perforated appendix. I have a tube draining it now.

Windchime
Post 3

@Potterspop - I see what you mean about the confusing symptoms. At the start it could be difficult to know if these things are really serious or not.

I heard that another typical sign of appendix pain is if your stomach hurts when you cough, but this won't be the same for everyone. It makes sense to see a doctor if you have pain and other symptoms mentioned in the article. They will have procedures and tests to confirm or rule out an appendicitis diagnosis.

CaithnessCC
Post 2

Though it's true that you almost always have to have surgery for a perforated appendix, surgery isn't actually the go-to method for general appendicitis treatment. I found this out a few years back when my sister was having a lot of digestion problems which we found out later were actually related to her appendix. We thought that her doctor would advise surgery immediately, but he didn't.

Apparently, some people have on and off problems with mini flare ups which then settle again. The risk of course is that it may become a major problem at any time.

Acute appendicitis leaves you no choice but to have a life saving operation. Personally I wouldn't risk waiting. The appendix serves no real purpose so I would advise people to have it removed at the first sign of trouble!

Potterspop
Post 1

I know quite a few people who have had this problem, but how can you be sure you have appendicitis symptoms, rather than just a stomach upset, food poisoning or something similar?

Most people tell me they waited a long time to get medical help, and for two of them this meant it ruptured, as described in the article.

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