Types of Appendicitis | Where is the Appendix | Acute Appendicitis

Where is the Appendix

Appendix is a vestigial organ situated at the junction of small and large intestine. The base of the appendix can be marked on the surface as the McBurney’s point, which is situated at the junction of the lateral 1/3rd and medial 2/3rd of the line joining the anterior superior iliac spine and the umbilicus. McBurney’s point is the classical site of tenderness in appendicitis. Appendix varies in length, but the average length is about 10cm in adult. It is present only in human beings and certain anthropoid apes.

Types of Appendicitis

There are four type of appendicitis

  1. Acute appendicitis
  2. Sub-acute appendicitis
  3. Recurrent appendicitis
  4. Chronic appendicitis

Acute Appendicitis

  • Acute appendicitis is the most common surgical condition of the abdomen. Acute appendicitis may occur at all ages, but is most commonly seen in the second and third decades of life. There is hardly any difference of gender incidence, but this condition seems to be more commonly seen in teenage girls.

Sub-acute appendicitis

  • The sequence given in acute appendicitis is not inevitable. Some episodes of acute appendicitis apparently subside spontaneously before they reach the acute stage. This is called as sub-acute appendicitis.
    This condition may recur again. Presumably obstruction of the lumen due to lymphoid hypertrophy or soft fecolith may spontaneously be relieved allowing subsidence of appendicular inflammation and its attendant symptoms.

Recurrent Appendicitis

  • If a full-blown appendicitis does not ensue, the appendix may turn into a ‘grumbler’ precipitating recurrent attacks. This is known as recurrent appendicitis. These attacks are usually milder. The patients remain symptom-free between attacks and physical examination is normal. Barium enema X-ray often shows normal filling of the appendix due to disappearance of obstruction.

Chronic Appendicitis

  • Sometimes pathological examination of the appendix may reveal thickening and scarring suggesting old, healed acute inflammation. This is called as chronic appendicitis. Patients with such appendicitis often complain of persistent right lower abdominal pain. The resected appendix shows fibrosis of the appendicular wall, evidence of old mucosal ulceration and scarring and infiltration by chronic inflammatory cells to be designated as chronic appendicitis.

Sub-acute, recurrent and chronic appendicitis are usually due to obstructive causes.
Non-obstructive appendicitis is a less dangerous condition as there is no obstruction there is not much distension but when the serous membrane is involved localized peritonitis develops and the patient complains of pain in right iliac fosse. Such inflammation terminates either by suppuration, gangrene, fibrosis or resolution. Many of the sub-acute, recurrent appendicitis and chronic appendicitis develop from this variety.


  1. Lilian said:

    Hi, I am 22 years old and I just visited a doctor today. From his diagnosis, he suspects sub-acute appendicitis. I have been having these pains on my right lower abdomen for some years now and I do not know what to make of it. I had Ultra sound today but no appendicitis was seen. I urinate regularly and normally experience intense pain before and after urinating. Please, could this be sub-acute appendicitis or urinary tract infection or what?

    March 17, 2010
    • PUP said:

      Appendicitis is a disease where there is inflammation of the appendix. An appendix is a small outgrowth of tissue forming a tube shaped sac attached to the lower end of the intestine. It is acute or chronic in nature equally affecting male and female. This disease accounts for at least half the emergencies occurring in young adults.

      Appendix pain starts around the umbilicus and gradually settles in the right iliac fossa.
      The other associated symptoms with pain are vomiting, fever, tenderness of the abdomen on touch.
      In chronic or sub acute appendicitis, there is recurrent pain in right iliac fossa ( rt side of abdomen), constipation, nausea and loss of appetite.
      Some times even sonography of abdomen do not reveal acute on chronic appendicitis, unless there is a resultant abscess formation. In such cases only clinical judgment by a physician is helpful.
      The other cause may be a small renal stone or urinary tract infection but the investigation are not supporting it.

      March 18, 2010
    • charlene said:

      For many years I had the symptoms that you mention. Because my symptoms were worse during ovulation and menstruation, my doctor suspected endometriosis. When a laparoscopy was done, he didn’t find endo, but did found fibrous bands of scar tissue covering my strictured appendix (no longer infected)and the scar tissue had adhered it to my pelvic sidewall. Adhesions were also found attached to adjacent muscles. He believed that so many of my symptoms were likely related to the scar tissue and the chronic irritation they probably caused–including irritation to bladder and pelvic muscles. Scar tissue doesn’t show up well on CT scans, ultrasounds, or MRIs—so if physicians aren’t trusting you to know your own body, they conclude nothing is wrong.

      April 4, 2010
  2. Ash said:

    I have had very mild (dull) pain in the lower mid-right side of my abdomen, almost near my groin since Jan 2009. My physician ruled out an inflamed appendix based on a physical examination and referred me to a gynecologist. The gynecologist advised an ultra-sound of the lower abdomen (which did not cover the appendix) but the uterus, ovaries etc. were fine. I had an ultra sound repeated in March 2010, it was suggestive of poly cystic ovaries. I also had white creamy vaginal discharge since the time the pain started (Jan 2009). It’s non-itchy but foul smelling. My physician suspects I have slight pelvic inflammation, hence the discharge. He has advised me to get a Barium Meal X Ray of Ileo-Cecal Junction done to rule out an infection/inflammation of the appendix. Is that the right X Ray to diagnose appendix problem? And could the pain also be due to ovarian cysts/ PID/ UTI? (The pain is very mild but always present)

    March 30, 2010
    • PUP said:

      There are two things involved, one is polycystic ovarian disease, the other probable cause can be an sub acute appendicitis.
      The pain is not at the classical site of appendicitis, that is Mcburney’s point.
      Do you have any associated symptoms like fever, vomiting, constipation?
      If sonography is not revealing the appendix, X-ray Barium meal of ileocecal region is helpful in detecting the chronic appendicitis. Other investigation is CT scan of pelvis and abdomen.
      The surgeon is the best judge to decide about the appendicitis, as it is well evident subjectively.

      April 3, 2010
      • Ash said:

        The Barium Meal X-Ray of ileo-cecal junction came out normal. My physician said it’s not a case of sub-acute appendicitis. I don’t have symptoms like fever, vomiting, constipation either. Can it be an infection in that part of the intestine where I was having the pain?

        Interestingly, I took a medicine (meftalspas) to relieve my menstrual camps yesterday and the pain has more or less subsided since then. Could it have been due to the polycystic ovaries? Do I need to see a gynaecologist?

        April 7, 2010
  3. Sh said:

    My father is 45 years of age he is having pain in right side of abdomen, doctor suspected acute appendix, he advised USG, that showed appendicitis, he gave some medicine called O2, and has advised bland diet, and to wait for some time. Is operation necessary? what is the point of view if usg report declared acute appendix?

    April 3, 2010
  4. AK said:

    I am 32 years old and I visited a doctor 3 days before. From his diagnosis, he suspects sub-acute appendicitis. I had pains on my right lower abdomen but no fever or vomiting. I had Ultra sound yesterday the result was sub-acute appendix with the size of 5.1 cm length; diameter of 1.2cm please tell me that weather I go for a treatment or operation?

    April 24, 2010
    • PUP said:

      Appendicitis is inflammation of the appendix. There can be acute, subacute and chronic type of appendicitis. In sub acute variety there is recurrence of the symptoms. Whether to treat conservatively or to operate will depend on many factors such as tenderness of the abdomen, the blood investigation, the sonography report. In such cases only clinical judgment by the physician is better.
      Have you done the blood investigation?

      April 24, 2010
  5. pk said:

    Today, I got my ultrasound report. It says “markedly thickened, edematous (measuring 8.4 mm in diameter) and non-peristaltic appendix is seen in right iliac fossa”. Though I don’t have fever, vomiting, loss of appetite, I sometimes feel a little tenderness on that right lower abdomen area. Doctor will be seeing the report next week. Could you suggest what should I do to avoid surgery?

    September 25, 2010
  6. Rhoda said:

    For about a year now, I have been feeling pain in my lower abdomen. Between November and December this year, it became very serious. I have gone for scan twice to different doctors. The report said “There is tenderness to sonographic probe, raising a suspicion of sub-acute appendicitis”. Does this indicate Acute Appendicitis or some other type of appendicitis?

    January 5, 2012
  7. NK said:

    I have inflamed appendix. Doctors say it is of sub acute variety. What is the solution of this kind of appendicitis?

    December 17, 2012
    • PUP said:

      Often sub acute variety can be treated conservatively. However, the best person to determine what is necessary during that time is your surgeon. Considering the condition of your health, he may decide and advise you for the same.

      December 18, 2012

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