What Is a Ruptured Appendix, and What Does It Feel Like? An ER Doctor Explains
Key takeaways:
A ruptured appendix can happen when the appendix gets infected (appendicitis). It’s when small holes form in the appendix, and can lead to a more serious infection.
It’s important to get medical care if you have symptoms of appendicitis, such as pain in the lower right abdomen. This can help prevent complications like a ruptured appendix.
A CT scan is the only way to know for sure if you have a ruptured appendix. Treatment usually requires a combination of antibiotics and surgery.
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It can be hard to know when abdominal pain is an emergency. Gas, cramping, and minor infections can usually be treated at home. Other times, abdominal pain is caused by more serious conditions — like appendicitis. And this is a medical emergency.
When appendicitis is left untreated, it can lead to a ruptured appendix (also sometimes called a “burst appendix”). This complication can lead to a more serious, even life-threatening infection. One in 6 people with appendicitis will have their appendix rupture. So it’s important to know how to recognize the symptoms of appendicitis, and if it comes to it, the symptoms of a ruptured appendix. This way, you can get the care you need as soon as possible.
Quiz: Do I have appendicitis?
What is a ruptured appendix?
A ruptured appendix happens when an infected appendix bursts open. To understand this, it helps to know some basic information about the appendix.
The appendix is a tiny pouch attached to your intestine. It doesn’t really serve a purpose the way other parts of the intestine do. In most people, it’s located on the right side, in the lower half of the abdomen. And it can easily become infected.
When the appendix becomes infected and inflamed, the walls can become weak. As this progresses, small holes can form in the walls. This is a ruptured appendix. You may also hear it called a perforated or burst appendix.
When you have a ruptured appendix, stool that’s traveling through the intestine can leak into the abdomen. This can lead to a more serious infection. We cover this in a little more detail later in the article.
When to go to the ER for abdominal pain: Experts explain the causes of abdominal pain that are medical emergencies. And when to get help.
What does appendicitis feel like? Three people explain their experience with the symptoms of appendicitis.
Appendicitis treatment: The treatment for appendicitis can vary depending on how serious your infection is. Learn about the different appendicitis treatment options.
Signs and symptoms of a ruptured appendix
The signs of a ruptured appendix start with the symptoms of appendicitis. People with appendicitis often have:
Pain around the belly button or right bottom part of the abdomen
Pain that worsens with movement
Fever
Loss of appetite
When the appendix ruptures, there’s usually no explosion or extreme pain. People with ruptured appendicitis may have no noticeable difference from the symptoms above.
The longer a person has appendicitis, the more likely their appendix is to rupture.
So people with ruptured appendicitis are more likely to:
Have pain all over their abdomen
Have symptoms for more than 1 day
How do you diagnose an appendix rupture?
Diagnosing an appendix rupture is the same as diagnosing an appendicitis. A healthcare professional can learn a lot just by hearing about your symptoms and examining your abdomen. But the only way to diagnose an appendicitis or appendix rupture is with imaging tests.
There are a few different imaging tests that are used to diagnose appendicitis:
For most people, a CT scan is the best way to look at the appendix.
In children, an ultrasound can sometimes get a good look at the appendix. And this is preferred over a CT scan because there’s no radiation involved.
In pregnant people, an MRI can look at the appendix. This is preferred to prevent any radiation exposure to the fetus.
These imaging tests can show appendicitis and can also show ruptured appendicitis.
But sometimes the holes in the appendix are so small that the imaging studies can’t see them. So some people don’t know if their appendix is ruptured unless they go to surgery, and the surgeon can see it.
How is a ruptured appendix treated?
If you’re diagnosed with appendicitis, the first step in treatment is IV (intravenous) antibiotics. The next question is if you need surgery.
For people with appendicitis, some get surgery and others don’t. But it’s a little more complicated if your appendix is ruptured. In this case, your healthcare team will recommend one of the following:
Surgery right away
Surgery after a few days of IV antibiotics
Something called percutaneous drainage, which is a procedure that uses a needle to drain the infection.
After a few days in the hospital, most people are sent home with antibiotic pills.
Why is a ruptured appendix dangerous?
As we mentioned above, a ruptured appendix allows stool and bacteria to escape into the abdomen. This can cause serious problems, such as:
The bacteria can infect other parts of the abdomen.
The bacteria can get into the blood and cause a severe form of infection called sepsis.
Abscesses can form, which is a collection of infected fluid (like pus).
An intestinal blockage may occur.
Studies suggest that as many as 1 in 25 people with a ruptured appendix become dangerously ill. So this is why it’s important to get medical attention right away if you have symptoms of appendicitis.
When to get medical attention
If you or someone you know has any of the signs of appendicitis listed above, see a healthcare professional right away. As a reminder, this includes pain:
Around the belly button or right bottom part of the abdomen
That’s getting progressively worse
That worsens with any movement
With fever, vomiting, or complete loss of appetite
When you get medical attention, it’s also better to go to an ER rather than an urgent care. Most urgent care facilities will not have the ability to diagnose or treat appendicitis.
The bottom line
An infected appendix can rupture, leading to serious complications. The longer a person has appendicitis without treatment, the more likely they are to have their appendix rupture. This is why it’s important to listen to your body. You should be evaluated in an emergency room if you’re worried you have appendicitis. Timely diagnosis and treatment can make a big difference in keeping you well.
Why trust our experts?
References
Bickell, N. A., et al. (2006). How time affects the risk of rupture in appendicitis. Journal of the American College of Surgeons.
Körner, H., et al. (1997). Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis. World Journal of Surgery.
Potey, K., et al. (2023). Study of outcomes of perforated appendicitis in adults: A prospective cohort study. Annals of Medicine and Surgery.
Prachanukool, T., et al. (2021). Clinical prediction score for ruptured appendicitis in ED. Emergency Medicine International.
Yamazaki, S., et al. (2021). Predictive factors of perforated appendicitis: Impact of the C-reactive protein level. Surgery Open Science.
