What does appendix pain feel like? - David R. Flum

In April 1961, the Sixth Soviet Antarctic Expedition took a harrowing turn. Doctor Leonid Rogozov, the team’s only physician, began feeling weak and feverish, with an excruciating pain in his right side. After a few days, it became clear that he had appendicitis, an infection that can cause the appendix to burst.

And Rogozov knew that if his appendix did rupture, it would likely kill him. Outside a blizzard raged, making it dangerous for him to leave the station, or to have anyone else travel in. So Rogozov faced a gut-wrenching choice: wait for help that may never come, or cut open his own abdomen and remove the appendix himself.

While Rogozov’s predicament may have been extreme, appendicitis is not uncommon. It affects roughly 1 in 12 people. So, what causes appendicitis?

And why is this organ so prone to bursting? The appendix is a small, worm-shaped pouch attached to the large intestine that houses a diversity of gut microbes. Scientists long speculated that it was a useless artifact of evolution.

Recent evidence shows that this organ independently evolved in many different mammals. This suggests that it probably has some function, though it's likely subtle. One possibility is that the appendix serves as a reservoir for healthy gut bacteria, or it may play a role in mounting immune responses.

What we do know is this puzzling organ can cause serious complications. Most cases of appendicitis start with some sort of obstruction. For example, a small, dried piece of stool, called an appendicolith, can lodge itself in the organ’s entrance.

Other times, pathogens like viruses or parasites activate the immune system, causing inflammation. This immune response may even be triggered by one of hundreds of species of bacteria that normally reside in your gut. As a result, nearby lymph nodes swell, effectively closing off the appendix’s opening.

Because the appendix is a closed loop, when it's sealed, pressure builds quickly. This creates the perfect environment for bacteria to colonize and overgrow. As the inflamed appendix bloats, discomfort sets in.

And this pain is different from your everyday stomach ache. It typically starts near the belly button and then migrates to the lower right abdomen and intensifies. If left untreated, the appendix can continue to stretch, hindering blood flow and weakening the organ walls.

Eventually, this can cause the appendix to rupture, allowing the infection to spread within the abdomen, where it can pose fatal consequences. Thankfully, not all cases of appendicitis will lead to a rupture, but it's impossible to know exactly when or if the appendix will burst from symptoms alone. So, it’s recommended that all people with severe abdominal pain seek immediate medical attention.

Since doctors first identified appendicitis in the late 1800s, an appendectomy, or the surgical removal of the appendix, has been the standard treatment. It’s normally performed quickly, within 24 hours of diagnosis. Doctors remove the inflamed organ, which can double in size, either through one large incision, or through several smaller incisions using a camera and small instruments.

Recovery is typically quick, and most patients are discharged within a day or two. Though, if the appendix has burst, surgery can be more extensive as any bacteria and pus need to be thoroughly cleaned from the abdominal cavity. In the long term, living without an appendix is unlikely to lead to any health issues.

Today, thanks to medical advances, many patients avoid surgery altogether. Doctors have learned that appendicitis can often be treated with a simple course of antibiotics, started in the emergency room and continued at home. No matter the chosen course of treatment, it’s likely to be less distressing than Rogozov’s, who, after giving himself local anesthesia, removed his own appendix, stitched himself up, and resumed his regular duties just two weeks later.

Nevertheless, thanks to his story, doctors on remote stations in Antarctica now know to bring plenty of antibiotics to treat appendicitis, just in case.