Can appendicits (not a burst appendix) present mildly?

(Don’t worry … don’t need answer fast, and I have a GI appointment tomorrow :o )

The question in brief:

Can mild, subclinical, but persistent pain be a symptom of appendicitis? Absent vomiting, diarrhea, fever, etc. … would mild pain in the lower right abdomen lead a doctor to think “early onset of appendicitis” first?

I’m thinking the answer has to be “Yes” – but I’m also thinking that sever pain + fever are so correlated with appendicitis that an absence of those symptoms might lead to a summary dismissal of any appendix concerns.

Mild lower right abdominal pain has lasted about a week so far. Varies in intensity … call it varying from 0.5 to 2 on those “1-10” pain scales hospitals use. Worse when laying down, better when standing.

I’m not a doctor. The plural of anecdote isn’t data, yada, yada, yada.

When I was 9 in 1974 I started to have this weird, severe bloating in my stomach and had stiffness in my lower back. Lasted a few days until one morning I thought I was going to explode. Not that I was going to puke, but that my stomach was going to burst like a balloon. Went to the ER was rushed into surgery, and got my appendix out. The surgeon said it was within minutes of going nuclear.

In addition, this was a small town, so the surgeon was my family doctor and actually did a house call the first day of bloating and stiffness. Since he didn’t rush me to surgery that day, I’m inferring that he didn’t think it was appendicitis.

So, yes - in my case at least, no fever, no pain, and initial symptoms not recognized as appendicitis.

Good thing you have that appointment with the GI tomorrow!

More anecdata: Ya. 10 days of what felt like a sharp gas pain in the lower right quadrant. It would hurt if I moved suddenly a certain way, but was otherwise not particularly bothersome. Went to the doc because unlike gas pain this wasn’t moving and I had an idea what LRQ intestinal pain meant. Doc said location was right for appendicitis, but no other GI trouble, no fever, nothing. Doc suspected kidney stones because there was a tiny bit o blood in my pee. I sure as hell responded positively to the rebound test, though. CT tech did the scan and told me firmly to go straight to the ER and then call my doc to discuss the test. Surgeon confirmed it had gotten yuuge and was near to bursting. I never did look into the blood pee thing.

I had the bloating at first too (Ms. P said it sounded like I was getting my period), but it was only a few hours before In was in agony. It wouldn’t surprise me that sometimes it’s more gradual.

Thanks for the anecdotes, everyone. When the pain first started, it was mild enough for me to brush it off and give it a few days to pass. Only it’s not passing, so time for a professional opinion. I understanding that getting to a bad appendix before it ruptures, like Inigo reported above, is much preferred over letting it get out of hand and then dealing with infection of the vidcera.

Just curious - where do you live that you can go straight to a gastroenterologist for something like appendicitis rather than seeing a family doctor first?

Yes, appendicitis can present with mild symptoms and is notoriously hard to diagnose in many cases. There’s even a recognized entity of chronic appendicitis which can present with non-severe symptomatology.

There is a controversy over whether many cases of appendicitis can be safely managed with antibiotics instead of surgery.

Since appendicitis is a common cause of right lower quadrant abdominal pain and the consequences of missing it can be serious, ruling it out (i.e. with physical examination, lab and CT testing) is a major diagnostic consideration.

Louisiana :shrug: Making an appointment directly with a specialist has never been an issue for me. The office visit co-pay will be higher for me than for a GP appointment, but that’s OK. If something is wrong, I’d like to get it addressed ASAP. Adding in a GP visit would’ve just delayed everything a day or two.

Plus, if something is wrong and I have to go in for emergency surgery, the GI specialist is adjacent to the hospital where the surgery would take place.

Interesting - I hadn’t thought of the US for your location, given “La Rive Ouest”. I was thinking France or Quebec (because of the French) or the West Bank in/controlled by (depending on your politics) Israel. Here in Canada, you have to have a referral from a family doctor or an ER in order to see a specialist (with certain exceptions), and so I was just interested what the process is in other countries.

“Rebound test” is part of the palpation when he/she goes “boing” on the belly (here)?

I hurt when he scoops with a straight hand, but that’s because of my* foie gras.*

are you sure its not gallbladder problems? I was sick with constant problems for 2 or 3 years and told I had a hernia…then after it almost killed me and they removed what was left most of the problems disappeared

Right, the rebound test is when they have you lying defenseless and mostly naked on the doctor bed and they casually press your soft LRQ. Stop & hold. Ask you if that hurts. You say, “Naw, that’s ok.” Then they say, “OK, and this…?” as they withdraw their hand. If the birds flutter away from nearby rooftops to escape your screams it’s indicative of appendicitis.

Not sure of anything. But my pain is so mild (even if persistent), it’s hard to make the mental leap to “serious medical condition.” So, I’m going to have it checked.

The doctor might poke around, look at some tests, and tell me it’s something minor. But maybe not – I need to give myself a chance to avoid something serious. Kicking the can down the road because “it doesn’t hurt so bad” might be OK for a knee or shoulder … but not for the abdomen IMHO.

In my case, the west bank of the Mississippi River. There’s a group of adjacent suburban communities near New Orleans collectively referred to locally as “The West Bank”.


I always thought appendicitis had a high fever. And vomitting. I guess they will see in the blood work. Good luck.

ETA my Granny use to say if you lay flat and raise your right leg, no pain, no appendix. Pain? Go to the ER.

Some insurance plans in the US have that requirement, while others do not.

How do you know it’s not appendicitis? Because there’s a scar there. So much so, that traditionally when doing any surgery at that location, you remove the appendix. So that subsequent doctors aren’t mislead by the scar. Because the scar was the only thing they had to tell them it’s not appendicitis.

The symptoms for appendicitis are so vague that you can’t tell it’s not appendicitis without the scar to indicate prior removal.

Furthermore, inflammation of the appendix (“appendix - itis”) sometimes resolves, just like any other inflammation. It doesn’t always lead to bursting. So if you’ve got pain, and it goes away, who’s to say it wasn’t appendicitis?

Back in the day, when they used to do tonsil and appendix and uterus removal more casually, the pathologist would always be able to find some small area of inflammation on an appendix, to make the doctor not look bad. You get inflammation on bits of your body all the time, all over the place.

So… yes, you can get a mild inflammation of the appendix, that doesn’t cause much pain, that lasts for a while, that doesn’t lead to a burst appendix. Or it might be just constipation. Or you might be dying. As the drug companies say “if pain persists, see your doctor”

Same in N.J., Fl.,and Tn.

Update for anyone who may search this topic in the future:

The doctor suspects an abdominal muscle strain. I passed all the poking-&-prodding tests with flying colors. He ordered bloodwork (done) and an ultrasound (next Monday) just to be certain nothing is going on, but he seemed pretty certain about dismissing any appendix concerns.

I didn’t expect an abdominal muscle strain to feel so “deep” … figured it would be more of a “surface” sensation (though I do have slightly numb and tingly/itchy skin right over where the pain presents). But now that he’s gotten “strain” in my head, the pain does seem to get better or worse depending on my posture, or whether I’m bending or reaching or things like that. Laying on my back is bothersome, while laying on my stomach brings much (if not complete) relief.