Sepsis and Appendicitis

Appendicitis is the inflammation of the appendix, a small organ attached to the large intestine. It was believed that the appendix didn’t have any function, but this belief is changing. One theory is that appendix serves as a reservoir for beneficial gut bacteria. It may have a role in our immune system, as well. But since we can live without our appendix, it is often removed if it becomes infected. The surgical procedure is called an appendectomy.

Your appendix can become inflamed (irritated and swollen) for several reasons. It can be blocked by mucus, stool (bowel movement), or lymphatic tissue. This is part of the lymphatic system that helps fight infection. The normally harmless bacteria in the appendix then attack the appendix walls. This causes inflammation and infection. Bacteria, viruses, and parasites from your digestive tract can also cause an infection. If left untreated, the appendix wall can burst, causing the infection to spread in the abdomen, possibly resulting in sepsis or septic shock.

Sepsis may also occur as a complication of the surgery. If the surgical incision (wound) becomes infected, or an infection occurs in the abdomen, this can cause sepsis.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Suggested Citation:
Sepsis Alliance. Sepsis and Appendicitis. 2023. https://www.sepsis.org/sepsisand/appendicitis/

Updated November 8, 2023.

 

More About Appendicitis

Symptoms

There are three stages of appendicitis:

  1. Normal appendix
  2. Uncomplicated acute appendicitis (still intact)
  3. Complicated appendicitis

Appendicitis warning signs, including appendicitis pain, are not always obvious at first. Inflammation can develop for up to 48 hours before anyone notices symptoms. Because of this, it is essential to seek medical help when the symptoms do appear. The usual signs and symptoms of appendicitis include:

Early symptoms

  • Constipation, diarrhea, or gas
  • Dull, achy pain beginning around the belly button (navel), turning to sharp pain in the lower right abdominal pain
  • Loss of appetite
  • Low fever
  • Nausea and vomiting
  • Rebound tenderness: tenderness when pressure applied to the lower right abdomen is released

More advanced symptoms

  • Abdomen swelling and rigidity (hard)
  • Pain on the right side of the abdomen when pressed on the left side
Diagnosis

There are no specific appendicitis tests and appendicitis is usually suspected based on the typical symptoms. To confirm the diagnosis, the doctor may order some tests, like a urinalysis to examine the urine. This is to rule out other causes for the symptoms, like a urinary tract infection or kidney stones.

Blood tests can show signs of infection, which increases the chance that this is appendicitis. Finally, imaging tests like an X-ray or a CT scan can confirm appendicitis or find another other issue that could cause the symptoms.

Treatment

Some doctors have started treating simple appendicitis with antibiotics before going ahead with appendicitis surgery. According to an article from the University of Washington Medical School:

“In the first three months after taking antibiotics for the condition, nearly 7 in 10 patients in the antibiotic group avoided an appendectomy. By four years, just under 50% had the surgery,” said Dr. David Flum, co-principal investigator and professor and associate chair of surgery at the University of Washington (UW) School of Medicine. “Other outcomes favored either antibiotics or surgery. Putting it all together, antibiotics look to be the right treatment for many, but probably not all, patients with appendicitis.”

However, many people with appendicitis still have an appendectomy. The type of appendectomy depends on whether the appendix has burst or is still intact.

An appendectomy for an intact appendix is usually done laparoscopically. This is a minimally invasive appendix surgery. There are no large scars. Instead, the surgeon makes some tiny incisions and inserts special equipment with a camera. The surgeon watches through the screen as they move the tools to detach and remove the appendix. Healing is usually much faster with this type of surgery.

If there are complications or the appendix has burst, the surgeon will likely have to do open abdominal surgery. The surgeon must make a larger incision to see inside the abdomen. After removing the appendix, the surgeon cleans out the abdominal cavity to reduce the risk of infection, which could lead to sepsis. Surgery may not always be necessary though. Sometimes an abscess blocks off the infected area, keeping the infection contained. If this happens, the doctor may offer antibiotics first to see if that will get rid of the infection.

People who had a burst appendix often must stay in the hospital, usually with IV antibiotics, for three to five days to ensure the infection is treated properly.

Related Resources

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Appendicitis

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Linda S.

In August of 2022, I was diagnosed with a ruptured appendix, peritonitis, and sepsis, the symptoms being masked by taking 20.milligrams of prednisone. (Sepsis and Appendicitis) It is very rare for a woman of 70 to have their appendix burst, but fortunately I had a very skilled surgeon who was able to remove it laparoscopically, and I have no deficits from being septic or any lingering emotional issues, most likely because I was unaware of how sick I was. The doctors let me know that without treatment, I would have been dead in a day, maybe two from septic shock. ... Read Full Story

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Brian Mann

I am a sepsis survivor. I had not heard of this condition until I developed it, despite having a medical family. In 2018 I started having stomachaches that came and went in early June. This was a time when food poisoning was occurring throughout the nation with fresh produce greens, which I had eaten. The stomachaches came and went, but never became any worse – until one day, I began sweating despite cold skin. Then over the course of 6 hours, my stomach hurt worse and worse until I was driven into the emergency room. A CT scan revealed appendicitis. ... Read Full Story

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Autumn-Nicole B.

I survived mass sepsis after my appendix burst at fifteen. It was not caught in time and destroyed half of my reproductive system. (Sepsis and Appendicitis) I went through months of post sepsis admits. This past year I came down with a sore lymph node under my arm and I literally went to sleep from the pain at the end of April 2022. Finding myself waking up in the I.C.U. with a PICC line an open incision with a vacuum in it from having sepsis with necrotizing fasciitis. After many surgeries and a three week stay in the I.C.U. I ... Read Full Story

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Barbie Nesser

Hi my name is Barbie and I am 62 years old. It was June of 2020 when I had my 4th UTI in 6 months. (Sepsis and Urinary Tract Infections) I was prescribed Macrobid on June 10th. By Friday I was experiencing back pain. It was late in the day, but I decided to call my primary doctor. Luckily my doctor called me back. She asked if we could FaceTime. My doctor thought I did not look very well and I also developed a stye in my eye and I never had them before. It was evident that I was ... Read Full Story

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Jenny M.

I suffered with an abscess on my appendix for two years, brushed off by doctors, before my body finally couldn’t hold off the infection anymore and I went through peritonitis and sepsis. (Sepsis and Appendicitis) I cannot begin to explain how severe the pain was or the way my body started to shut down. I could feel I was going to die. As grateful as I am to be alive, the trauma of my illness and recovery is something I will always have to live with. So often symptoms of sepsis are brushed off as something else, but the pain ... Read Full Story

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Appendicitis