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Common Questions 

These questions are meant to increase your understanding of Appendicitis, what causes it, and why it is commonly misdiagnosed. 

What is appendicitis?

Appendicitis is simply the infection and inflammation of the appendix. The appendicitis is a small organ, the shape of a pouch, attached to the large intestine. It is located in the lower right portion of your abdomen. [1]

What causes appendicitis? 

Appendicitis is caused by the obstruction or blocking of the lumen, which is the ring-like opening that connects the appendix to the large intestine. Obstruction occurs for many causes like hardened stool, swollen tissue, or excess mucus. [2]

What are some common misdiagnoses for appendicitis? 

Gastroenteritis — an infection and inflammation of the stomach and small intestine often called the “stomach flu” — is the most common misdiagnosis of appendicitis because the symptoms can be very similar. Constipation is also a frequent misdiagnosis, as it can cause localized abdominal pain and bloating. Other common misdiagnoses include urinary tract infections and kidney stones, especially in women, since they can cause pain in the lower abdomen and flank.
 
In children, doctors often mistake appendicitis for inflammation of the lymph nodes in the abdomen or viral respiratory infections. In women of childbearing age, misdiagnosis rates are especially high as symptoms are often mistaken for pelvic inflammatory disease (infection of the female upper reproductive organs), ovarian torsion (when an ovary twists around the ligaments that support it), or ruptured ovarian cysts (when fluid-filled sacs on or inside the ovary burst). [3]

Who is most commonly affected by appendicitis misdiagnosis? 

Appendicitis affects people of all ages, but appendicitis misdiagnosis can affect certain individuals. Women are disproportionately affected, studies showed that 33% of women especially those of childbearing age, because symptoms often mimic gynecological conditions like those listed above. The elderly are also frequently affected by appendicitis misdiagnosis, as they have a higher baseline misdiagnosis rate. Multiple existing health issues can mask classic signs such as fever and lower-right abdominal pain. Pediatric misdiagnosis is also common as children can have a hard time communicating their exact symptoms. [4]

What are some other factors that contribute to the misdiagnosis of appendicitis? 

Atypical presentations is a leading cause as fewer than 50% of appendicitis cases present with the classic symptoms such as abdominal pain migrating to the lower right. Overlapping symptoms with other diseases and conditions often lead to patients being admitted to non-surgical units. A complex medical history can also delay or hide the need for targeted abdominal imaging. [5]

Women are disproportionately affected by appendicitis misdiagnosis.

Women are disproportionately affected by diagnostic delays in acute abdominal and pelvic conditions. Studies show that women with ovarian torsion wait on average significantly longer for correct diagnosis than men with equivalent abdominal emergencies. If you are a woman experiencing sudden and severe abdominal or pelvic pain that is not improving you have a right to request imaging and a gynecological consultation. Advocate for yourself! 

[1] https://my.clevelandclinic.org/health/diseases/8095-appendicitis

 

[2] https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543

 

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC11055627/

 

[4] https://pubmed.ncbi.nlm.nih.gov/7782616/

 

[5] https://pubmed.ncbi.nlm.nih.gov/32150270/

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