I think it is time we had a crash course on that famous anatomic and diagnostic enigma, the appendix.

The appendix is a muscular tube the diameter of a standard pencil and of variable length located at the very beginning of the colon, where the small intestine dumps our unneeded food goo so that poop can be formed. It has no known critical function. You can find a picture of it here.

There is a cluster of lymph nodes at the opening of the appendix that tend to enlarge, especially in older children and young adults, which obstructs the appendix. Sometimes a hard piece of poop (known as a fecalith) blocks the appendix tube. The appendix then begins to cramp, causing a bellyache around the belly button area and nausea/vomiting. This results in overgrowth of the bacteria, normally in relatively small numbers, in the appendix. This is the beginning of appendicitis. If the blockage continues, the appendix swells and the infection begins to involve the tissues around it. Much like a boil or pimple hurts when you touch it, the pain of appendicitis at this stage moves down to the right lower belly (or wherever the appendix actually is) and gets much worse. Now there can be fever and chills.

By this time, the patient will have been seen by a doctor, sent to a surgeon, and the appendix is then taken out. However, some patients are of strong constitution, or have an appendix that is hidden behind the colon, or don't have typical symptoms described above - and then the diagnosis is delayed. Now the infection has caused the swelling in the appendix to be so bad that the artery to the appendix cannot get blood to it. When this happens, the wall becomes thin and allows the infection to spread outside of the appendix into the belly. In most people, the rest of the organs and fat in the belly move over to "wall off" the area to keep the infection from spreading widely. This may become an abscess, or pus pocket. In others, this mechanism fails and the infection spreads widely and into the blood. Traditionally, the process of spread of infection to outside the appendix has been called "perforation". In addition, if the perforation stage is reached, the tendency is that patients take longer to recover after the appendix is removed, have repeated infections in the belly or in the incision, and even, rarely, die.

At no time in the process is there an explosion. At no time in the process can the statement be made "if your appendix had stayed in another 5 minutes, you would be dead!" I have seen young, healthy patients with early appendicitis have life-threatening recovery problems, and I have seen horrible, gangrenous, perforated appendixes come out of patients who go home the next day, feeling well.

The point is, the earlier the diagnosis the better, but it is also harder to diagnose appendicitis early (there are ALOT of things that cause pain around the belly button and nausea/vomiting!) Sometimes it is necessary to watch the patient a while in the hospital. Sometimes a CT scan will help. Sometimes surgery is done and the diagnosis is not appendicitis (we take it out anyway). Sometimes appendicitis is present, but the patient gets better with antibiotics and no surgery. Sometimes, no matter what is done, the appendix is "perforated".

Remember, if you have symptoms similar to those described above, see your doctor. Remind him or her that the best and most efficient way to find out if you have appendicitis is a surgeon's evaluation.