Actress Portia de Rossi was hospitalized in March with severe abdominal pain. The "Arrested Development" star underwent emergency surgery for appendicitis.
According to her wife, Ellen DeGeneres, Portia said she wasn't feeling well and went to bed at about 7:30 p.m. Sometime later, as Ellen related, she woke up abruptly, saying: "I look over and Portia is not in bed next to me. I get out of bed and I find Portia on the floor on all fours. And I'm like, 'Baby, are you okay?' And she says, 'Yeah, I'm okay.' And I said, 'Well you're okay if you're playing Twister by yourself, but you're not okay. You're on the floor.'"
Ellen drove her to the emergency room where she was diagnosed and taken to surgery. Due to COVID restrictions, Ellen was not allowed to stay at the hospital with her. "That's upsetting to me. They sent me home, and I'm crying," she said, and then jokingly added: "Because someone was chopping onions at the nurse's station."
De Rossi was discharged on March 22. As Ellen : "I am happy to report Portia is feeling much better now. She's home." Always the jokester, DeGeneres then added, "Not all of her -- she left her appendix at the hospital. I'm going to auction off the appendix for charity. I'm kidding, it's gonna go on eBay."
Appendicitis
Appendicitis is an inflammation of the appendix, a finger-like, blind-ended pouch connected to the cecum. The cecum is located at the junction of the small and large intestines.
In the U.S., appendicitis is the most common cause of acute abdominal pain requiring surgery, and the lifetime risk is 8.6% for males and 6.7% for females. Appendicitis is most common among those in their teens and 20s, but can occur at any age.
Symptoms
The most common symptom of appendicitis is pain in the abdomen.
In a "typical" case, the clinical course of the pain:
- Begins as colicky periumbilical pain and moves to the right lower quadrant
- Gets worse in a matter of hours
- Feels worse with movement, deep breathing, coughing, or sneezing
- Is severe and often described as different from any pain ever felt before
- Occurs suddenly and may awaken a person from sleep
Other symptoms of appendicitis may include:
- Loss of appetite
- Nausea/vomiting
- Constipation/diarrhea
- Inability to pass gas
- Low-grade fever
- Abdominal swelling
- Feeling that having a bowel movement will relieve the discomfort
Other abdominal conditions that can mimic the symptoms of appendicitis include:
- Abdominal adhesions
- Constipation
- Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis
- Intestinal obstruction
- Pelvic inflammatory disease
Most often, healthcare professionals suspect the diagnosis of appendicitis based on symptoms, medical history, and physical exam. An ultrasound, CT scan, or MRI exam may help confirm the diagnosis. CT scan has a greater than .
MR imaging has reported sensitivity of 97-100%, specificity of 92-93.6%, and accuracy of 92-94% for the .
Complications
If appendicitis is not treated, it may lead to complications. The most common complication of untreated appendicitis is appendiceal rupture with the development of peritonitis, a potentially life-threatening condition. Symptoms of peritonitis include:
- Fever
- Nausea
- Severe abdominal tenderness
- Vomiting
- Abscess of the appendix (appendiceal abscess)
What Causes Appendicitis?
Appendicitis can have more than one cause, and in many cases, the cause is not clear. Possible causes include:
- Blockage of the opening inside the appendix
- Enlarged tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
- Inflammatory bowel disease
- Stool, parasites, or growths that can clog the appendiceal lumen
- Abdominal trauma
Treatment of Appendicitis
The first elective appendectomy was performed by Abraham Groves in 1883, and since that time, the early treatment of appendicitis has traditionally been focused on surgery.
According to , most uncomplicated appendectomies are performed laparoscopically. Laparoscopy usually results in less pain, faster recovery, and the ability to use smaller incisions.
In cases where there is an abscess or advanced infection, the open approach (laparotomy) may be needed. In the presence of an abscess from a ruptured appendix, a percutaneous drainage procedure may be performed, thus allowing a decrease in inflammation and a lower surgical risk for a later appendectomy. In addition, patients are typically covered with broad-spectrum antibiotics.
In the 1990s, European investigators began to study whether a conservative approach using antibiotics as a primary treatment for appendicitis was feasible. Reports show that appendicitis treated with antibiotics has a 91% success rate in the short term, with .
A 2018 review by found that approximately 90% of patients treated with antibiotics are able to avoid surgery during the initial admission, and the other 10% who fail to respond to antibiotics require a rescue appendectomy. Recurrence rates of non-operated patients within 1 year are as high as 20-30%.
The authors concluded that in uncomplicated appendicitis without risk factors, a "shared decision based on the patient's preferences should be made." Appendectomy is recommended for those with risk factors. Complicated appendicitis could be treated with immediate surgery, or primary antibiotic treatment (with/without drainage of any abscesses), followed by later appendectomy.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.