Imagine you're on an airplane with your favorite soccer coach and then oh boy that pesky little organ called the appendix develops appendicitis and of course you are rushed to the operating room to surgically remove it because that's the only way to treat appendicitis. Or is it? Could there possibly be a legitimate way to avoid surgery when someone gets appendicitis? And if there is, does that mean there's a medical conspiracy and that we've all been lied to? Well, today we're going to find out by taking a look at a real human appendix, talk about what it does, how someone develops appendicitis, and of course, talk about the legitimate treatment options. I'm Jonathan Ben with the Institute of Human Anatomy, and it's time to get into this anatomical awesomeness. So, let's start with the basics. Ted Lasso was right when he corrected Coach Beard on the location of the appendix. It is located in the right lower quadrant of the abdomen, just medial to this bony landmark that you can see on Jeffrey the skeleton called the anterior superior iliac spine. Most often abbreviated as the asis because who wants to say anterior superior iliac spine all the time unless you're an overly enthusiastic anatomy teacher. But if we go into the dissection here, you can see we're in the abdominal cavity and it'll reflect this fatty little apron out of the way called the greater um and then you can see this bouquet of guts down here which is essentially the majority of the small intestines. And if we go over to the right lower quadrant, you can see the first segment of the large intestine called the seeum. But coming off the seeum is this wormlike structure that you can see here. Technically called the vermapform appendix. Vermapform just means wormlike, but most of us just call it the appendix. But look at this thing. That's it. It's just a few inches long. And this pesky little critter is responsible for nearly 250,000 appendecttomies per year, which we'll get to if those appendecttomies are really necessary in just a second. But what is the appendix supposed to do? Well, for many years, some thought the appendix was just considered a vestigial organ. Basically, a useless leftover structure from evolution. But some research has suggested that it might have some purposes, albeit purposes that you can live without. But it is loaded with lymphatic nodules, which control the bacteria entering the large intestine, or in other words, provides some level of an immune response for the large intestine. Some scientists have even suggested that it may act like a safe house for the bacteria that make up your gut microbiome, helping to repopulate your intestine after something like a bad case of diarrhea wipes some of them out. But again, people tend to be able to repopulate their gut microbiome even without an appendix as one's diet tends to be one of the biggest contributors of the gut microbiome. But what is happening when appendicitis develops? Appendicitis is when the appendix becomes inflamed and it really isn't a party that you want to be invited to. One of the common causes of appendicitis is a blockage inside the appendix. This could be from a falith and lith means stone. So this is a hardened stool. The blockage can also come from food particles or even lympoid tissue swelling up and clogging the tube. You could kind of think of it like a traffic jam in a tiny tunnel. And when the appendix gets blocked, bacteria that normally lives in your gut starts to party like it's spring break, multiplying like crazy inside the appendix. And again, this is not the party that you want to be invited to because this leads to inflammation, swelling, and sometimes even pus buildup. And if the blockage isn't cleared, the appendix can swell so much that it cuts off its own blood supply, leading to tissue death, or worse, it can rupture. A ruptured appendix is definitely something that we want to avoid because it can spill bacteria and pus into the whole abdominal cavity causing a serious infection called peritonitis. And this is why appendicitis is considered a medical emergency. Symptoms usually start with a vague pain around the belly button that migrates to that right lower quadrant. People might also feel nauseous, have a fever, lose their appetite, and in some cases have diarrhea. So, who's at risk for developing appendicitis? Well, technically it can happen to anyone, but it's most common in people between the ages of 10 to 30 with the highest incidence within that group being 10 to 19 years old. Now, there are certain risk factors that might increase your risk like a family history of appendicitis or conditions that cause inflammation of the gut, but most of the time it's just bad luck. But now that we know what causes this mess, is surgical removal of the appendix the only way to treat appendicitis? Well, the answer to that question is technically no. You can successfully treat appendicitis with antibiotics alone. Now, whenever you tell students this, many of them start to think conspiracy. The United States just wants to push all patients into surgery and cut everything out of them that they possibly can. And surgeons are just anxiously waiting in the O, deviously twirling their scalpel in their hand just waiting for their next surgical victim. Well, aside from that description being very dramatic, there's a little bit more to this antibiotic treatment story. Yes, studies like one from 2015 called the APAC trial or APAC trial showed that antibiotics can successfully treat uncomplicated appendicitis, meaning cases where the appendix hasn't ruptured, there's no abscess, and imaging shows it's just inflamed without major complications. In these studies, patients were given IV antibiotics in the hospital, followed by oral antibiotics at home for about a week, and around 60 to 70% of them avoided surgery altogether, at least in the short term. The antibiotics work by controlling the bacterial overgrowth, reducing inflammation, and potentially allowing the body to clear the blockage naturally. But here's the catch. About 20 to 30% of people treated with antibiotics end up needing surgery anyway within the next year because the appendicitis comes back. And this is where we get into why surgery is still the standard of treatment in most cases. First, surgery, specifically called the appendecttomy, is a definitive fix. You remove the appendix and there's no chance that a patient is going to end up back in the hospital with appendicitis. And in the United States and many other countries, we're pretty good at apppendecttomies. These are typically done laparoscopically, meaning small incisions with a tiny camera, which is less invasive than open surgery. And when I was doing my general surgery rotations, we did a lot of apppendecttomies. And once the patient is under general anesthesia, it takes about a half hour to perform this procedure. Plus, recovery is usually quick with most people getting back to normal within a week or two with very few complications. Another reason why surgery is typically preferred is that complicated appendicitis like a rupture or abscess is a big deal. A ruptured appendix or a nasty abscess can be life-threatening if not treated quickly. In the US, doctors often lean toward surgery because it's harder to predict which cases might go from uncomplicated to complicated. Imaging can help, but it's not foolproof and waiting too long can be risky. And it's probably not going to be too shocking that studies show that delaying surgery in complicated cases increases the risk of death, especially in older patients or those with other health conditions. So yes, with certain mild cases of appendicitis, antibiotic treatment alone may be appropriate if the patient doesn't have physical findings of diffused peritonitis or imaging that shows evidence of an abscess or perforation. But the patients must understand the risk and be willing to accept the greater uncertainty of possible disease progression despite antibiotic treatment and even the increased risk of getting appendicitis again. Hands down the number one question we get asked is what's the best way to study anatomy and learn about the human body? And our answer still hasn't changed. It's the cadaavver lab. But we also know that not everyone has 247 access to a lab. And that's why we created our digital anatomy resources to bring the clarity and depth of the cadaavver lab right to your screen. Whether you're looking at our illustrated atlases, visual flowcharts for physiology, or clinical anatomy breakdowns, these tools are designed to help you learn faster and retain more. And if you really want to take your study game to the next level, check out our study bundles. These bundles combine everything from anatomy flowcharts to quizzes, physiology guides, flashcards, and more, all in one downloadable package. So, if you are asking, "What's the best way to study anatomy?" The Cadaavver Lab is still king. But these digital study bundles can be your new study sidekick. So, click the link below, grab a study bundle, and start learning anatomy the way it was meant to be studied, clearly, visually, and confidently.