What Is a Ruptured Appendix, and What Does It Feel Like? An ER Doctor Explains

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. 

EXPERT PICKS: WHAT TO READ NEXT

• 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.  

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Written by:

Heather Farthing MD, MPH

Dr. Heather Farthing is currently practicing emergency medicine in Texas. She works clinical shifts in Austin and in Harlingen.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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