Untreated appendicitis may cause your appendix to rupture (burst), resulting in an infection. Symptoms associated with a ruptured appendix include severe abdominal pain, fever, chills, and weakness.
Appendicitis is inflammation of the appendix. This small, thin, finger-shaped sac is located on the lower right side of your abdomen, where your small and large intestines connect. Most doctors think the appendix doesn’t have an important function and can be removed without causing harmful effects.
If your appendicitis is left untreated, your appendix can rupture (burst). When this happens, bacteria get released into your abdomen and can cause a serious infection.
A ruptured appendix, also known as a perforated appendix, can make you very sick and is sometimes hard to treat.
The risk of rupture increases the longer that appendicitis treatment is delayed. The risk is about 2% 36 hours after symptoms start. After that, the risk increases by about 5% every 12 hours.
The biggest risk factor for a ruptured appendix is delaying treatment for appendicitis. The longer you wait to address your symptoms, the higher your risk.
According to a 2018 literature review, younger children are more likely to have a ruptured appendix than older children. This is because they have more trouble explaining their appendicitis symptoms to others.
The exact cause of appendicitis is unknown, but experts think an infection triggers inflammation inside the appendix.
For instance, If something blocks the opening of the appendix, an infection can follow. Bacteria can get trapped inside the appendix and multiply quickly, causing appendicitis. Viruses, parasites, and stool buildup may cause the blockages and infections that result in appendicitis. Inflammatory bowel disease (IBD) is another possible cause of appendicitis.
When appendicitis isn’t treated promptly and correctly, bacteria or pus build up. As this happens, pressure increases and the appendix swells. Eventually, it swells so much that the blood supply to part of the appendix gets cut off. That part of the appendix wall dies, and a hole or tear develops in the dead wall. The high pressure pushes the bacteria and pus into the abdominal cavity.
A ruptured appendix usually oozes or leaks into the abdomen instead of bursting like a balloon.
Risk factors for appendicitis
Appendicitis can happen at any age, but it often affects children and teens between the ages of 10 and 20 years. It’s more common in people who were assigned male at birth.
Having other family members with appendicitis can increase your risk too. Children with cystic fibrosis are also more likely to have appendicitis.
Appendicitis symptoms can be similar to those of other conditions that affect the abdomen, such as a stomach virus or an ovarian cyst. For this reason, it can be hard to tell if you have appendicitis.
The classic symptoms of appendicitis are pain starting around the belly button and then vomiting. Several hours later, the pain moves to the lower right abdomen.
If you have these symptoms and think it might be appendicitis, seek medical attention as soon as possible. Quick treatment is essential to avoid a rupture.
Other symptoms of appendicitis include:
- abdominal pain that may start in the upper or middle abdomen but usually settles in the lower right abdomen
- abdominal pain that increases when you walk, stand, jump, cough, or sneeze
- a bloated or swollen abdomen
- tenderness when you push on your abdomen, which may get worse when you quickly stop pressing on it
- an inability to pass gas
- nausea along with vomiting
- decreased appetite
- constipation or diarrhea
Keep in mind that not everyone who gets appendicitis has these classic symptoms. It’s common for kids and older adults to have more unusual symptoms.
In babies and children, the pain is often spread out all over the abdomen. Caregivers should look for pain that starts around the child’s belly button and moves to the right side, along with appetite loss and fever.
In older people, the abdomen may be less tender, and pain may be less severe.
Appendicitis inflames the appendix and causes it to swell. Without treatment, the pressure eventually reaches the point where the appendix bursts. This can happen as quickly as 48 to 72 hours after your symptoms start.
Once your appendix ruptures, you may have a variety of symptoms. At first, you may feel better for a few hours because the high pressure in your appendix is gone, along with your original symptoms.
When bacteria leave the intestine and enter the abdominal cavity, the lining of your abdominal cavity becomes inflamed. This condition is called peritonitis.
Peritonitis can be very serious and very painful. It requires immediate treatment.
The symptoms of peritonitis are similar to those of appendicitis, except:
- the pain is in your whole abdomen
- the pain is constant and more severe
- your fever is often higher
- your breathing and heart rate may be fast because of fever, infection, or severe pain
- you may have other symptoms, including chills, weakness, and confusion
When you have an infection in your abdomen, the surrounding tissues sometimes try to wall off the infection from the rest of your abdomen. The wall forms an abscess, a closed-off collection of bacteria and pus.
Symptoms of an abscess are also similar to those of appendicitis, except:
- the pain may be in one area (but not always the lower right abdomen), or it may be in your entire abdomen
- the pain can be either a dull ache or sharp and stabbing
- the fever doesn’t go away, even when you take antibiotics
- you may have other symptoms, such as chills and weakness
When left untreated, the bacteria from a ruptured appendix can enter your bloodstream, causing a serious condition called sepsis. Sepsis is inflammation throughout your entire body.
Symptoms of sepsis include:
- fever or a low temperature
- fast heartbeat and breathing
- low blood pressure
The treatment for a ruptured appendix is to remove your appendix with surgery.
Doctors sometimes wait to perform surgery on a child who isn’t in any immediate danger. The surgeon will drain infected fluid from the abdomen, have the child take antibiotics, and remove the appendix later. The name for delayed surgery is interval appendectomy.
The treatment for peritonitis is to clean bacteria out of the abdomen during surgery.
You’ll usually get antibiotics through a vein, at least for the first few days. You may need to receive hospital treatment for 10 to 14 days to ensure the infection is gone.
Often, your appendix will be removed right away. If there’s a large abscess, your doctor might want to drain it before surgery. A tube inserted into the abscess lets the bacteria- and pus-filled fluid drain out.
This process can take several weeks. You might go home with the drain in place, and you’ll need to take antibiotics while the drain stays in place.
Once the abscess is drained and the infection and inflammation are controlled, your doctor will perform your surgery.
Antibiotics are the main treatment for sepsis. It’s important to start taking these medications as soon as possible, because the infection is life threatening if left untreated.
Duration of treatment may vary, but shorter treatment courses are generally preferred, according to a 2020 study.
You’ll need to take antibiotics once your ruptured appendix is removed or a drain is put into an abscess. You’ll typically take antibiotics before, during, and after surgery.
The length of antibiotic treatment will vary. Your surgeon will analyze your case to determine the best plan for you.
One 2021 study recommended that postsurgical antibiotic treatment be limited to
Open surgery (instead of minimally invasive laparoscopic surgery) is typically used for a ruptured appendix. It helps your doctor ensure all of the infection is cleaned out.
After surgery, you’ll need to keep the incision clean and dry. Avoid taking a bath or shower until your doctor says it’s fine to do so.
It can take up to 6 weeks to fully recover from open surgery. Try not to lift anything heavy or participate in sports or other strenuous activities during this time. Your recovery will take longer if you have a drain inserted and shorter if you have a laparoscopic procedure.
You may take strong prescription pain medication for a few days after surgery or after a drain is placed. After that, you can usually manage the pain with over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
Your doctor may encourage you to get up and walk as soon as possible after surgery. You may have to adjust your diet and eat smaller meals while you heal.
You should be able to return to work or school around 1 week after surgery, depending on how you feel.
Considerations for children
A child whose appendix has ruptured may need to stay in the hospital for 1 week or so.
Others may come home with a special tube called a peripherally inserted central catheter (PICC line) so they can get antibiotics through a vein at home.
Kids should stay on a liquid diet for a couple of days after surgery. They should wait until they have their follow-up visit with the surgeon, and get the surgeon’s approval, before going back to their regular activities. This could take up to 3 weeks.
Without quick treatment, a ruptured appendix is a life threatening condition.
When the appendix hasn’t perforated, the risk of death is under 1% according to a
Treating a ruptured appendix increases the odds of survival.
If you get medical attention right away for appendicitis, you have a better chance of fully recovering if your appendix ruptures. That’s why it’s important to see a doctor if you have any symptoms of appendicitis.
There’s no way of knowing when or if appendicitis will happen, so you can’t prevent it. However, you can avoid a rupture if you get immediate treatment.
The key is to know the symptoms of appendicitis. If you have any abdominal pain combined with nausea or other symptoms, get medical help immediately.
See a healthcare professional even if you’re unsure if your symptoms are appendicitis. It’s better to find out that you don’t have appendicitis than to wait and have your appendix rupture.