Symptoms of appendicitis


The main symptom of acute appendicitis is pain in the right lower abdomen.

The symptoms of acute appendicitis begin with dull, diffuse and not precisely localizable abdominal pain around the navel (periumbillical).

Within a few hours, the pain moves to the right lower abdomen and from then on it is a constant and very precisely localizable permanent pain ("point pain"). This pain is often made worse by coughing and walking. Such a shift in symptoms shows the change between visceral ("intestinal pain") pain and somatic ("body pain") pain. The pain is often accompanied by vegetative symptoms such as nausea, vomiting, diarrhea or constipation. At the same time, a slight fever of up to 38.5 ° C occurs.

In the case of a perforation (inflammatory breakthrough through the intestinal wall into the abdominal cavity), symptoms of brief relief and pain relief may occur. This short-term improvement is, however, caused by the subsequent peritonitis (Peritonitis) worsened again.
The pain spreads further in the abdominal cavity and is often accompanied by a deterioration in the general condition. If rapid therapeutic intervention is not taken, the patient can suffer septic-toxic shock (blood poisoning with bacterial toxins).

When diagnosing appendicitis, it should be remembered that only 50% of those affected have typical symptoms. Small children and the elderly in particular have disease courses that are associated with less typical symptoms.


diarrhea does not provide a clear indication of a Appendicitis in many other diseases of the Digestive tract, especially the intestines, can become more or less strong Diarrhea come. So they are not a conclusive symptom of appendicitis, but they often appear as Concomitant symptom on.

In combination with the typical pain symptoms or general pelvic pain diarrhea is relatively common in locally advanced appendicitis. It is important for the attending physician to consider and review this option, as it is often done by one Colon inflammation (Enteritis) is assumed. This assumption delays the determination of the actual disease situation and thus worsens the prognosis for the patient.


Flatulence can accompany appendicitis, but it can also be misleading. By the inflammatory process in the presence of a appendicitis can it to Indigestion come that result in symptoms like diarrhea or constipation demonstrate. Also Flatulence can result from these circumstances, but give in no way a clear indication an existing appendicitis. The pain caused by severe flatulence can be misleading. Because the air moves in the intestine, the pain caused by the bloating can also move. The feeling that the characteristic pain symptoms could be present is intensified. By Massages or hot water bottles However, gas can be cured in most cases - pain caused by appendicitis, however Not.


Because appendicitis caused by bacteria is triggered, the body reacts, as with any major bacterial infection, with a rise in temperature - the patient gets fever. Due to the increased temperature, the immune cells of the Immune system work better, but only for 38 to 40 ° C applies. The peculiarity of fever during appendicitis is that Temperature difference between the armpit and the rectum. Is the difference more than 0.5 ° C and step additionally stomach pain or even characteristic symptoms, this can be a good indication of appendicitis (appendicitis).

Symptoms in the child and toddler

Recognizing the symptoms in children or toddlers can make great demands on the treating doctor. Young people behave differently from adults during illness and the effects on their bodies vary significantly.
The immune system is not yet as developed as that of adults. It follows from this that it is not possible to react quickly to an infestation with pathogens. The infection can establish itself sooner and progress in the further course. That is why rapid disease progression is typical in children with appendicitis. The symptoms are more massive than is the case in adult patients.

The characteristic pains that occur in many cases in adults are mostly of no use in children. Infants and children usually lack the ability to qualitatively assess pain or to specify its precise location. The general condition can worsen if there is pain or abdominal pain can be perceived as nausea. When dealing with young patients, care must be taken to spread as little excitement as possible and to try to evaluate the child's statements from the outside.

Also read: These are the symptoms I can tell if the child has cervical inflammation

In addition to the pain, symptoms such as Vomit and fever. In addition, the classic way of increasing in children white blood cells on (Leukocytosis), which is due to the immune system's attempt to control the infection.

As the inflammation progresses rapidly, it is more common in children Intestinal perforation (Intestinal breakthrough) because the bacteria have infiltrated and destroyed the intestinal wall. As a result, a Peritonitis, one Peritonitis, out. Here, too, the course is more stormy than in older people.
The level of development of the Greater omentum plays a key role here. At the Greater omentum it is the so-called Belly mesh. It mainly consists of Fat depositsthat are a barrier between the Abdominal organs and the Peritoneum form. It also contains many immune cells.
With children it is Greater omentum firstly, it is not yet too big and secondly it does not have enough fat to effectively seal off infections. As a result, peritonitis is more common and it spreads quickly.

Since the diagnosis of appendicitis can turn out to be extremely complicated, the examining doctor should always weigh up other possibilities and exclude them diagnostically. Other inflammations of the Gastrointestinal tract can cause similar symptoms.
Also one pneumonia (lung infection) or one meningitis (Meningitis) can be responsible for various symptoms, which also occur with appendicitis.

Note: appendicitis in young children

Appendicitis (appendicitis) at Toddlers is characterized by particularly stormy gradients. The symptoms show up with very pronounced vegetative symptoms, such as vomiting, fever and rapid increase in white Blood cells (Leukocytosis). In addition, the perforation rate is particularly high in small children.

Symptoms in both men and women

There are no fundamental differences between the symptoms of appendicitis (appendicitis) in men and women. However, appendicitis is more common in men.

In both sexes, the course of acute appendicitis begins with unlimited abdominal pain that cannot be precisely localized, which is usually described in the area around the navel. After a while, usually a few hours later, the pain slowly migrates to the right lower abdomen.
There it can be localized easily and remains constant for the time being. If the pain is made worse by walking or vigorous body movements such as coughing, it may be another sign of appendicitis. The symptoms are accompanied by other signs such as nausea and vomiting, but also by diarrhea or constipation. Usually there is also a slight fever.

If there is a perforation - the inflammation breaks through the intestinal wall - it is not uncommon for the pain to decrease. A sudden reduction in pain is usually not a good sign, because after a brief state of improvement, stronger pain often follows, which is the inflammation of the peritoneum (peritoneum) signal. Now the pain is no longer necessarily limited to the right lower abdomen, but can occur holistically with a worsening of the general condition. If in this acute emergency situation not acted quickly and the appendix is ​​removed, blood poisoning with shock condition (septic-toxic shock) can occur.

Not all people, whether female or male, show symptoms as clear as just described. Almost half of all cases of acute appendicitis occur with less severe initial symptoms and are therefore recognized late.

Atypical or weaker symptoms are particularly affected by children and the elderly, in whom such infections can cause more than in healthy adults with an intact immune system.

Certain gender-specific disorders can produce similar pain and symptoms. Various diseases of the female internal genital organs, as well as the male testicles, can cause pain in the lower abdomen. Despite everything, the death rate is (Lethality) extremely low in appendicitis as long as no perforation has occurred. The mortality increases to 1% with a perforation.

You may also be interested in this topic: Duration of appendix irritation

Figure appendix

Figure appendix with appendix
  1. Appendix - Caecum
    (Light blue border)
  2. Opening the Bauhin flap -
    Ostium ileal
  3. Mouth of the appendix -
    Ostium appendicis vermiformis
  4. Free tape strip -
    Taenia libera
  5. Appendix -
    (Light green border)
    Appendix vermiformis
  6. End part of the ileum -
    Ileum, pars terminalis
  7. Ileum-appendix valve
    (Bauhin flap) -
    Ileal papilla
  8. Transverse folds of the colon -
    Plicae semilunares coli
  9. Colon, ascending part -
    Ascending colon

You can find an overview of all Dr-Gumpert images at: medical illustrations