10 Symptoms of the appendicite – Adults and Children

10 Symptoms of the appendicite – Adults and Children

Appendicitis is an extremely common disease, which affects about 7{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of the population, making it one of the leading medical emergencies worldwide. Inflammation of the appendix usually occurs between the ages of 10 and 30, but can occur at any age, although it is rare in children under 2 years of age.

The appendix is an organ of varying size and location, and its proximity to other organs of the pelvis and abdomen may cause the symptoms of appendicitis to be similar to those of other diseases.

If you are looking for information on the types and most frequent causes of abdominal pain, visit: DOR NA BARRIGA | ABDOMINAL PAIN | Main causes .


In fact, some of them, such as diarrhea, constipation or abdominal distension, occur in less than half of the cases.

Next, we will talk more about each of these 10 symptoms, demonstrating their importance for the diagnosis of appendicitis. We will first describe the clinical picture of appendicitis in adults and then in infants, children and adolescents.


The most typical symptom present in almost 100{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of cases of appendix inflammation is abdominal pain. As abdominal pain can be caused by dozens of different problems, knowing the typical characteristics of appendicitis pain is important for your diagnosis.

A) Typical appendicitis pain

The appendix itself is a poorly innervated organ, so at the beginning of an appendicitis, when the inflammation is restricted only to the appendix, the brain has some difficulty in recognizing the exact location of the intestinal tract that is suffering. Although the appendix is located in the lower right quadrant of the abdomen, the pain of an appendicitis in its first 6 to 8 hours is usually located around the navel. The patient can not accurately determine the location that hurts. When questioned, he makes a circular motion with his index finger around the navel.

Over the first 24 hours, as the inflammation worsens and reaches not only the appendix, but also the surrounding intestinal loops and the peritoneum (the membrane surrounding the gastrointestinal tract), the brain begins to receive more precise messages from the Site, making it clear to the patient that there is some problem in the lower right region of the abdomen.

This poorly located pain pattern around the navel, which in a matter of hours migrates to the lower right quadrant of the abdomen, becoming restricted to a well-defined point, is the most typical symptom of appendicitis occurring in more than 60{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of the Cases. Whenever a physician treats a patient with this type of abdominal pain, the hypothesis of appendicitis should be prioritized.

When the peritoneum is affected, the pain of the inflammation of the appendix intensifies, and the palpation of the abdomen becomes very painful. The pain is also aggravated when the patient coughs, tries to walk or make any sudden movement with the trunk.

At physical examination, there is a typical sign of acute appendicitis called decompression pain or Blumberg’s signal. This signal is investigated as follows: we press the right lower abdomen with our hand and ask the patient if he feels pain. In general the answer is yes. Then we suddenly removed the hand that pressed the belly and observed the behavior of the patient. When there is appendicitis, with irritation of the peritoneum, this rapid removal of the hand causes an intense pain in the place, much stronger than the pain caused by the compression of the abdomen.

Pain of appendicitis

Still in the physical examination, another common finding is a stiffening of the abdominal musculature. When the patient has an intra-abdominal inflammatory process, the tendency is for there to be an involuntary contraction of the muscles in that region, a sign we call “abdominal defense.” When palpating the abdomen of a patient with appendicitis, it is noted that the abdominal wall on the right is hardened and quite painful.

B) Other patterns of appendicitis pain

In fact, when the patient presents to the emergency room with the typical appendicitis pain, few physicians have difficulties in establishing the diagnosis. The problem occurs when the patient presents an atypical pattern of pain, or when the patient is unable to adequately describe his symptoms, such as in very young or elderly patients with dementia. Immunosuppressed patients, who do not develop exuberant inflammatory processes, may also have atypical presentations of appendicitis.

In about 15{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of people the appendix is located more posteriorly, making the location of appendicitis pain different. Instead of the typical pain in the lower right quadrant, the patient may complain of right lower back pain, pain in the upper right quadrant or pain all over the right flank.

There are also those patients with lower appendices whose tip extends to the pelvis region. In these cases, the pain may be in the groin on the right, in the anus or in the pubic region. Evacuation or urination may lead to exacerbations of pain.

C) appendicitis with pain in the left side of the abdomen

As you may have noticed, even in atypical cases, the pain of inflammation of the appendix is usually restricted to the right side of the abdomen. Although rare, it is not impossible for the patient with appendicitis to have pain on the left side of the abdomen if the appendix is longer than usual and extends to the left side of the abdominal cavity. However, appendicitis should not be the first diagnostic hypothesis in patients with abdominal pain on the left side, except in the rare cases of situs inversus (a rare condition in which patients present organs of the thorax and abdomen opposite to that expected).


Nausea, vomiting and loss of appetite are three symptoms that usually come together soon after the onset of abdominal pain. This malaise usually occurs in up to 90{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of cases of appendicitis.

As everyone knows, nausea, with or without vomiting, and loss of appetite are very nonspecific symptoms, which can arise in a multitude of distinct medical problems. However, when associated with a periumbilical abdominal pain pattern that worsens and migrates to the lower right quadrant within 24 hours, they make the diagnostic hypothesis of appendicitis extremely likely.

The classic triad of appendicitis symptoms is abdominal pain, vomiting and loss of appetite.


Fever is not usually present in the first few hours of evolution, especially in children and the elderly. Some people, however, may have a low fever, with temperatures around 37.5 ° C and 38 ° C.

Elevated fever usually does not occur in the inflammation tables of the appendix, except in the most severe situations, when there is perforation of the appendix and leakage of fecal material from the intestines into the abdominal cavity, which generates an intense inflammatory reaction and severe infection.


Significant diarrhea is an unusual sign in appendicitis. When present, the physician should consider other diagnoses as a matter of priority, although the possibility of inflammation of the appendix should not be entirely excluded.

Patients who have an appendix in a more pelvic location may have diarrhea if the inflammation of appendicitis also affects the rectum. In general, however, what the patient has is not properly diarrhea, but rather an increase in the frequency of bowel movements, without necessarily having large losses of liquid stools.

As with diarrhea, intestinal constipation is not a typical symptom of acute appendicitis. Most patients do not, but this does not mean that it can not be part of the clinical picture of an appendicitis.


Leukocytosis is a laboratory sign which means an increase in the number of leukocytes in the blood. Leukocytes are one of the most important defense cells of our immune system. When there is an ongoing infection or inflammatory process, one of the first precautions that our immune system takes is to increase the production of leukocytes.

More than 80{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of patients with acute appendicitis present leukocytosis on the blood count test. The more intense the leukocytosis, in general, the more extensive the inflammatory process.

If you want to better understand the results of your blood count, read: HEMOGRAM | Understand your results


The clinical picture of appendicitis in adolescents is basically the same as in adults. In children less than 12 years old, the symptoms may be slightly different.

A) Symptoms of appendicitis in children between 5 and 12 years

As in adults, abdominal pain and vomiting are the most common symptoms in school-age children, although the characteristic migration of pain from the periumbilical region to the lower right quadrant may not occur.

The frequency of signs and symptoms of acute appendicitis in this age group is as follows:

  • Pain in the lower right quadrant of the abdomen – 82{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Nausea – 79{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Loss of appetite – 75{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Vomiting – 66{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Fever – 47{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Diarrhea- 16{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}

B) Symptoms of appendicitis in children between 1 and 5 years

Appendicitis is uncommon in children under 5 years of age. Fever, vomiting, diffuse abdominal pain and abdominal stiffness are the predominant symptoms, although irritability, wheezing, difficulty walking and complaints of pain in the right hip region may also be present.

The typical migration of pain to the lower right quadrant of the abdomen occurs in less than 50{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4} of cases. Diarrhea and fever, however, are much more common than in adults. Young children usually have low fever (around 37.8 ° C) and flushing of the cheeks.

The frequency of signs and symptoms of appendicitis in this age group is as follows:

  • Abdominal pain – 94{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Fever – 90{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Vomiting – 83{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Decompression pain – 81{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Loss of appetite – 74{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Abdominal rigidity – 72{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Diarrhea- 46{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • The abdominal distension – 35{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}

C) Symptoms of appendicitis in children under 1 year

If the inflammation of the appendix in children under 5 is uncommon, the same picture in newborns and the first year of life is even rarer. The low frequency of appendicitis in this age group is probably due to the more tapered shape and less prone to appendage obstruction, as opposed to the more tubular shape of the organ in adults and older children.

Although rare, unfortunately, the neonatal mortality of appendicitis is almost 30{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}, since early diagnosis is very difficult, since the clinical condition is usually very atypical. Abdominal distention is more common than abdominal pain itself, a fact probably caused by babies failing to communicate properly.

The frequency of signs and symptoms of inflammation of the appendix in this age group is as follows:

  • Abdominal distension – 75{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Vomiting – 42{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Loss of appetite – 40{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Abdominal pain – 38{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Fever – 33{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Abdominal wall inflammation – 24{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Irritability or lethargy – 24{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Respiratory distress – 15{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Abdominal mass – 12{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}
  • Stool bleeding – 10{b246d8715a49a229bfad551fa6c95ff8dfd676e0f52344f95da00cc3b04a64a4}