Diagnosing appendicitis becomes more challenging as patients age, as they often do not have classic symptoms.

Glad you went to the ED and had a CT; sounds like you are doing better.

Below is a tool we use to help with decision making.

My dad had a burst appendix and gangrene had already set in. He almost died.

Hoping you heal quickly and with no serious events.

Oh, my!

That is almost exactly what happened with my son a few years ago. He was 19. A day of vomiting, and DH was feeling queasy, too. The next day DH was okay, DS had stopped vomiting but said his stomach was sore. well, yes,I told him that was normal, sore muscles from vomiting. So we all thought it was just a bug.

After a week he told me he still had a low fever and his stomach kinda hurt, so I called his doctor, He went in, they pressed around his abdomen, said it’s likely aooendicitis and sent us down the hall to the attached hospital ER.

It was a busy Friday night, first snow in a month, so the ER was packed. When they finally could take images and blood tests (8 hours later) it was appendicitis, but the surgeon on call was at another ER and couldn’t come till the morning. When she finally went in, they found the appendix had probably ruptured days before. There was so much ”gunk” (to use my own medical term) adhering to tissue, they couldn’t even get to the appendix without possibly causing other damage. So he stayed in the hospital for several days with a drain and antibiotic iv, then came home with a drain and oral antibiotic.

A few weeks later the drain was removed, more images taken, and they saw that, in fact, the rupture had healed! I didn’t know that could happen.

So, the choice of whether to remove it was his. After talking with the doctor, who like yours gave a balance of pros and cons, DS took into account his age which would give him many years for a possible recurrence, and he decided to have it removed. They did it laparascopically since he had no other issues.

The surgeon explained his lack of acute pain like this: the appendix is slightly curved. If the ends curve toward the outside, the inflamed appendix touches nerve endings making it acutely painful. If they curve to the inside, the appendix is less likely to touch nerve endings, so you might feel discomfort but not the acute agony. and in fact, that is how his appendix was.

I’m so glad you had a voice of experience to tell you to go the hospital! And who knew that appendicitis didn’t have to be so painful, or that it could heal? I hope you are feeling comfortable after the open surgery, and wish you many years of good health.

I would opt to remove it, to be safe. But, that is my opinion for my status. Have no idea what you have in your current health. Best wishes either way.

Antibiotics may be used instead of surgery for appendicitis. If interested, may find following article informative. https://www.health.harvard.edu/blog/surgery-for-appendicitis-antibiotics-alone-may-be-enough-2019010915692

ETA: article above written by Christopher J. Burns, M.D. a surgeon at Harvard Medical School.

Sorry but this story does not wash. An erupted appendix means all sorts of nasty acids are pouring into your abdomen and will eat away at your intestines and stomach. My neighbor almost died letting this go. You have wrong information or need to get to the hospital ASAP.

^^^Sure, Elmer, as in so many other areas of expertise.... /sarc

I thought the same thing as Arcy. If you have a ruptured appendix you need surgery. Some appendicitis can be treated with just antibiotics, but not a ruptured appendix.

Wow, what an ordeal!

I remember my doctor telling me that he removed my appendix when he tied my tubes....in my 20s. Apparently my intestines were wound around the appendix and it would have been a problem if the burst.

In fact, arcy_gw, it is not too rare that a ruptured (erupted is a term I've not heard before) appendix gets "walled off" by the surrounding inflammation, and so the rest of the abdominal cavity isn't affected. Therefore it is possible, and sometimes desirable, to treat with antibiotics and fluids, and wait and watch. There is plenty of evidence to support this.

It is also true that a ruptured appendix can be life threatening. But it isn't because of the "nasty acids eating away" (yes that stuff does cause problems because of the resulting inflammation) but, it is mostly because of the gross bacterial contamination in an area where bacteria doesn't belong - resulting in sepsis.

roxanna, several expert contributors with more knowledge than mdln the ER physician have spoken to contradict her and to also contradict the article from Harvard Med that she linked to. There's an obvious conclusion to reach, consistent with your comment.

Wishing you well.

Glad everything turned out okay for you.

What a weird thing and so glad your sister was there to share her experience. Glad you are all right and that you have the experts looking after you!

Amicus, that’s an amazing story. I am glad you followed your sister’s advice. I have to admit I probably would not have listened.

My neighbor’s daughter just had her appendix removed, but she is only 17.

She had the whole bit, vomiting, diarrhea, cramping, pain. She rallied a bit but by 10 PM she was in loads of pain. The sharp, stabbing kind, the kind that doubles you over. Quick trip to the ER and it’s acute appendicitis. They kept her comfortable overnight and she had surgery the next morning.

I’m not sure what I would do about surgery in your case. Its awfully hard to choose surgery when you can choose not to. Best of luck with your decision and I am glad you’re feeling okay.

So glad you are OK and feeling well. I'd want to do some thinking, maybe have some questions ready before I went back in three weeks. DId I understand odds are about equal as to whether this might come up again?

My concern would be.....I've discovered I don't heal as quickly at this age as I used to. A femoral hernia repair (outpatient) early July did not set me back two or three days like I'd expected, it was more like two or three weeks. If I added 5-10-15 years to my age and tried something like that again, I don't think the effort would be improved, or less. I might opt for doing it now rather than having it be even more tedious and drawn out later on.

But I'm glad you are fine, and I'm sure will be well enough informed you will make the right decision for you.

Arcy, your comment "Sorry but this story does not wash" made me laugh out loud. I find it amusing you think I would make up a story, or describe anything untruthfully...for what purpose, may I ask? My intention was just to relate my experience of a rather atypical case of ruptured appendix, so that it isn't assumed one has to have terrible right sided lower pain, to have appendicitis.

FWIW, I do not blame the Triage assessment for leaning towards the possibility of diverticulitis, as symptoms are quite similar, and that is more common in my age bracket. Most importantly, I didn't present with the most common appendicitis symptoms.

What raee mentioned above is exactly what happened to me, according to the surgeon. I needed no drain tube, as no toxins were spread throughout my abdomen, which would have been very serious and can be fatal if left untreated. He said it 'walled off' and did not spread infection throughout. As well, although all the scar tissue from my hysterectomy will make a future appendectomy a more invasive surgery, (than laparoscopy) it fortunately also acted as a barrier to keep everything contained right where my appendix ruptured.

I've come to realize that despite taking very good care of my health (annual physicals, good nutrition, daily exercise, on no meds, healthy weight, never smoked) some things just come out of left field, to keep life interesting I guess! My surgeon released me on Monday with no restrictions on diet or activities, so I've been back to normal since then. Thank you all for your responses and well wishes.

Glad you're doing okay now. Is appendicitis a genetic thing? My father and his brother both had it. If I were you given the 50/50 , I'd not have the major operation.

amicus, I'm so glad that you were able to catch it when you did and that you are feeling well now. I never knew that the symptoms could be so diffuse and intermittent. My brother at one time went in for appendicitis and they went in to remove it and found he had diverticulitis instead. Supposedly they removed his appendix anyway while they were in there, but who knows. But the symptoms for both can be very similar.

I had appendicitis at age 55. The ER nurse was certain it was gallbladder issues due to my age. The pain came on quickly and in less than 12 hours I went to the ER. I had no vomiting or nausea just a feeling that somone punched me straight in the stomach. I did not have the classic pain in the right side. I had surgery at 1:00 pm and was released from the hospital 7 hours later. Laproscopic surgery with minimal pain. I had a follow up with my GP when I got hime to Florida and he stated that perhaps I could have taken a course of antibiotics instead of having surgery. I changed doctors immediately. Worst pain I have ever had and it is something I would never want to repeat.

I would add waiting for the current high risk of nosocomial infection to drop in your list of reasons to delay surgery.

And to add to Raye's comment, whether or not the hospital is full of covid patients and whether ICUs have available beds or not.

Lily, I wonder if it can be generic, too. My father had it at 6 and my brother at 10, then DS at 19.

Our surgeon also said it occurs more often in males.

I am glad you are feeling better, amicus. Thank you for sharing your experience.

@bpath, yes!

Thanks, mdln! 'd better remind my sons if they have children to be on the lookout!

The same happened to my husband so we got him to the hospital, the wait was two and a half hours. When finally taken they wanted to wait to make sure it was his appendix, consequently, it burst and all hell broke out. They opened him up stat and the surgery was successful. It took a long time and I found out that they were missing one scalpel so they had to open up again and remove it. He was ten days in the hospital and then came home. Two weeks later the phone rang and a pathologist called to tell us that he had a tumor in the appendix and it's cancer. I almost fainted. No one ever gave us that info at the hospital. He came through the cancer ok.

Oh my goodness yayagal! I've not heard of THAT before! I'm so glad he came through!

Amicus, your sister is a hero! So glad she alerted you.

Oh my goodness yaya gal that must have been so scary and then cancer! I definitely would have fainted! I am so glad that the cancer has been done away with!

Thanks for the info, mdln. My sister reminded me that our mother had appendicitis, and an appendectomy as a young girl...so that makes 3 of us in my immediate family. Odd, because as bpath mentioned, it occurs more in males, but neither of my brothers has ever had appendicitis. I have told my children to beware of any migrating abdominal pain (that usually turns into lower right quadrant abdominal pain) fever, nausea...and even just uncomfortable build up of abdominal gas, like I had, in case they happen to not exhibit the most common symptoms either.

The male:female ratio for appendicitis is 3:2, so still plenty of females getting appendicitis (as your family demonstrated).

Yes Arcy I agree and burst appendix would cause peritonitis and need to be removed expeditiously. Is it possible that it was intact and a case of appendicitis? Additionally if the appendix is inflamed and infected, it's removal should be seriously considered, but I see where the surgeon might be hesitant due to the recent abdominal surgery and adhesions present. Previous surgeries complicate matters, particularly abdominal in nature. amicus my comments are not intended to be medical advice, but if you were my family member, my comment would be the same.

"amicus my comments are not intended to be medical advise"

You can be sure that few would find your words to constitute qualified and informed medical advice (not advise).

I find it quaint when people's medical knowledge comes from TV shows and they feel confident in sharing their opinions with others, in writing, on a thread with an actual doctor.

And if you come back and tell me your knowledge is from a source other than a TV, show, unless it's a medical degree, it's six of one, half a dozen of the other.

Interesting thread. I learned a few things as to how appendicitis presents itself. Good to know.

I’m glad all ended well for you. Hereditary is more evident in your case.

The pathology of appendicitis begins with various vectors in the large intestine near the appendix that eventually cause it to burst. Sometimes a heavy fiber diet can result in a small clump of fiber blockage there as they pass thru the digestive tract. If the appendicitis is from bacterial/viral/ or sometimes parasites, the bursting releases bacteria/virus into the abdominal cavity, causing sepsis. High fever soon follows. If the cause is benign (non bacterial/viral), fever may not present. Hereditary also plays a role in the way/angle the appendix is attached which can facilitate a blockage. Often the pain begins around the navel area then it may move toward the right side.

My brother and two of his sons have all had emergency appendectomies. Surgery is the only option in my very humble opinion.

"Hereditary is more evident in your case"

I think the word you want to use here is heredity. The misuse suggests you don't have much education or training in this subject matter.

"Surgery is the only option in my very humble opinion.

It's fine that your opinion is humble. Is it well informed too, from education and training?

My brother and two of his sons have all had emergency appendectomies. Surgery is the only option in my very humble opinion.

Is that your professional opinion as a physician?

Zalco, your post made me think of one of the last movies I watched, in 2021 no less! Person had no heart beat so they shock them with a defibrillator and save them. Don't these people consult with doctors, nurses, EMTs, or just some random person who may have had a BLS class in the past?

Another issue I have is basic military things, like dress and hair cuts in movies and tv shows. Watched a you tube video about a military plane going down the other day. A woman in the Air Force had her long hair in a freaking ponytail?!! It's so annoying sometimes. Watching a military person wearing their head covering indoors. Something so basic can ruin a show or movie for me sometimes. Being a nurse is even worse. I think that's why I quit watching medical tv shows.

Kathsgrdn How about the police dramas like CSI where they are always working in rooms with very little light?

@Kathsgrdn, Agree regarding medical shows/movies. Recently saw old episodes of "Doc Martin," filmed outside US, they did a surprisingly fair job of medical accuracy. The town is cute and countryside is beautiful.

"Greys Anatomy" and "Chicago Med" - just horrible; albeit haven't watched them in years. (Disclaimer: dear colleague [an excellent physician] is a consultant on Chgo Med.)

While outdated now, imho, ER did the best job of medical accuracy.

Please look for medical information on the ".edu" websites of major medical institutions, not facebook or television.

Is there a foxtv.edu? That's the only source many refer to.

I'm kidding about the URL.

palisades_ and barbara_tpa, keep hanging around and contributing please :-) We all understood what you meant. Spelling isn't everything, and experience can be a valuable gift to share.

Thanks for pointing out my misuse of the word Elmer. But you could have done better if you could contradict or disprove my post above with your knowledge on disease pathology and progression rather than making up your wild assumption as such. In fact, anyone beside Elmer please feel free to do so. We also have quite a few health professionals on here so that would make it more interesting in the right spirit.

palisades, thanks for understanding and replying in the same spirit that I wanted to but perhaps didn't do as gently as I should have. I have friends and relatives who are doctors of various sorts, including medical doctors. From such people and from my own providers, I've learned that very often diagnoses of diseases and conditions are nuanced and often tentative and uncertain, and appropriate actions or treatment options are often the same and more.

Few physicians in few situations will feel comfortable saying "if this, then always that", unless the question is "Should I turn my light off when I go to bed" Few matters physicians deal with are that simplistic. My impression in reading what you wrote was that it was unlikely you were talking about something about which you had education or training to deal with. Because your words suggested far too much certainty than I've come to expect from experts I know when discussing issues that are nuanced.

There are not "quite a few health professionals" who visit on this forum. There are a lot of pretenders who avoid answering what their qualifications are when asked, meaning, they have none. There's one ER physician who happens by periodically who is generous with her time (I believe it's a female doc) but who understandably keeps her comments at a high level and general. Except to debunk egregious comments made by pretenders who seem to do so regularly,

Expert advice is available from public sources, and many often refer to these. Not as personal opinions necessarily but to share the expert comments. Believe words from experts with scientific, medical or public health qualifications, not from media personalities or those who work in news or editorial positions. .

Few physicians in few situations will feel comfortable saying "if this, then always that", unless the question is "Should I turn my light off when I go to bed" Few matters physicians deal with are that simplistic.

Elmer, I agree with your point above.

My impression in reading what you wrote was that it was unlikely you were talking about something about which you had education or training to deal with. Because your words suggested far too much certainty than I've come to expect from experts I know when discussing issues that are nuanced.

To address your impression about too much certainty, if you notice when I illustrated the point that a fever being not present I did point out a probable scenario, but even so I would have to word it as, a fever maynot present. Note the bold words “may not” as there are some chances that some other contributing factors may cause a fever in a non bacterial/viral case. To me, it would be too much certainty if I were to conclude with “a fever will not present “. My other point on heredity was about phenotype expression so the example was specific.

I was being generous to say “quite a few” because there may be other health professionals who read this public forum may decide to participate to correct misinformation or to debate on a specific point, along with people who are already here.