What is ruptured appendix? - If there is delay in treating appendicitis, it may swell to the point at which it will burst / tear, spilling its contents into the peritoneal cavity (abdominal space containing the intestine, covered by a thin membrane known as peritoneum). The longer it takes to treat appendicitis, the higher the risk of rupture.

This may occur in 1-2 persons out of 10 who develop appendicitis. It is more common in children less than 5 years because they cannot describe precisely the kind of pain they have, thereby making early diagnosis more difficult than in older children and adults.

Why does appendix rupture?

When the appendix becomes obstructed, bacteria get trapped in it, rapidly multiplying and increasing in number. The body mobilizes white blood cells to the appendix to fight the bacteria multiplying inside it. This activity results in inflammation (swelling, pain) and formation of pus, if it is left untreated for a long time.

As the swelling continues, there is increased pressure within the appendix, which consequently results in reduction in blood supply to it. This leads to starvation of the cells of the appendix tissue and, ultimately, death of those cells. As the number of dead cells increases, the appendix tissue becomes weaker until it breaks open (rupture).

This allows the pus formed in the appendix, consisting of bacteria and white blood cells, gain free access to the abdominal cavity, resulting in peritonitis. 

How long does it take appendix to rupture?

Appendix can rupture within 48 to 72 hours after the onset of symptoms, thus necessitating the need for prompt diagnosis and treatment.

What are the signs and symptoms of ruptured appendix?

Immediately after appendix ruptures, a patient, previously having severe pain, may feel a little relieved. This is because the tension in the wall of the appendix, following its swelling, has been relieved due to the tear in its wall, allowing its content to spill into the abdominal cavity.

However, this relief is short-lived as generalized abdominal pain usually develops thereafter due to the spillage of the content of the appendix into the abdominal cavity. This is a serious emergency which needs immediate medical attention.

Other symptoms include: nausea, vomiting, diarrhoea, loss of appetite, as well as fever, accompanied by chills. There may also be generalized body weakness, fast breathing and reduction of urine volume once peritonitis (inflammation of the peritoneum) and sepsis set in. By this time, it is already becoming a serious problem.

How is ruptured appendix treated?

The treatment of ruptured appendix is surgery. Before surgery is done, antibiotics are given for reasonable length of time and there may be need to drain the abscess as much as it is feasible, with drainage tube. During surgery, the appendix is removed and whatever pus remains is drained.

Drainage tube may be left after the surgery for whatever pus remaining to find its way out through the tube.  The period of antibiotic treatment may be extended to allow the infection to resolve and surgical wound to heal well.  Other supportive measures are given the patients as necessary. 

What are the complications of ruptured appendix?

When appendix ruptures, it gives the bacteria in the intestine free access into the peritoneal cavity. This results in complications such as:

1. Peritonitis - This refers to the inflammation of the thin membrane tissue lining the abdominal cavity, resulting in generalized intense abdominal pain.
2. Abdominal abscess - This is pus formed in the abdomen which contains bacteria and white blood cells, mobilized by the body to fight the bacteria spilled into the abdominal cavity. The abscess is usually restricted to a limited region of the abdomen by abdominal organs that try to wall off and limit its spread. 
3. Sepsis - This refers to the infection spreading to other parts of the body through the blood, often due to delayed treatment. This may result in severe infection and septic shock.
4. Septic shock - This is a situation whereby blood pressure becomes very low despite that the person is not bleeding. It is due to expansion of the blood vessels, thereby pooling the blood required for circulation to remain inside the blood vessels, with enough blood unable to reach vital organs such as the brain, the heart, kidneys etc.
5. Death - Delay in treatment that results in sepsis may lead to death.

How can ruptured appendix be prevented?

Early presentation is very important when symptoms of appendicitis start manifesting. This will afford the patient the opportunity of prompt treatment to avoid complications.