Signs of Burst Appendix (Rupture or Perforation)

The appendix is a worm-shaped pouch that is located at the beginning of the large intestine in the lower right-side of the abdominal cavity. Since it originates from the cecum (the first part of the large intestine), the appendix is also sometimes referred to as the cecal appendix. The exact function of the appendix in humans is not clear. It is widely thought to be a vestigial organ. However, recent studies have indicated that it may have a potential role to play in gut immunity.

Why does the appendix burst?

Inflammation of the appendix (technically known as appendicitis) is a fairly common condition among teenagers and young adults. However, appendicitis can affect a person at any age, and is a frequent cause of abdominal pain. The treatment of appendicitis is usually thesurgical removal of the appendix. In fact, treating appendicitis through removal of the appendix is one of the most common abdominal surgery performed in the United States.

One of the serious complications of untreated appendicitis is the perforation (tearing) or rupture (bursting) of the appendix. This leads to spillage of the intestinal contents into the abdominal cavity, resulting in widespread systemic infection that could cause death. As a precautionary measure, the appendix is removed in appendicitis even if the appendix is not perforated or ruptured. Only when suitable surgical facilities and surgical skills are unavailable, a non-surgical treatment for appendicitis is considered.

Read more on appendix abscess.

What happens when the appendix bursts?

The major concern in appendicitis is that of a bursting appendix. The spillage of intestinal contents containing millions of bacteria and strong digestives juices into the abdominal cavity can cause heavy damage to the internal organs. Death can result from a burst appendix. Therefore, this condition must be treated as an emergency.

It is important to note that perforation or rupture of appendix does not happen in every case of appendicitis. In some cases, appendicitis can resolve on its own without treatment. However, keeping in mind the potentially lethal complications of a burst appendix, immediate medical attention must be sought in all suspected cases of appendicitis.

One of the complications of appendicitis is peritonitis or inflammation of the peritoneum. The peritoneum is a membrane that lines the abdominal cavity. At times, the ruptured area of the appendix may be sealed off by the formation of an abscess. This prevents the spread of the harmful intestinal contents into the abdominal cavity.

However, this containment is of a temporary nature. The abscess can also burst at any time, leading to sudden flooding of the abdominal cavity with the intestinal contents. In such cases, a patient’s condition worsens rapidly. Gangrene is also a potential complication. It is important to note that less than half of all cases of appendicitis display the typical symptoms of this condition.

Warning Signs of a Burst Appendix

Keeping in mind the above mentioned serious complications of a burst appendix, it is important to know the warning signs of an inflamed or burst appendix. The following are some of the key signs and symptoms that indicate a burst appendix.

Sharp pain in the abdomen

One of the most notable symptoms of a burst appendix is severe, sharp pain in the lower right quadrant of the abdomen. In cases of acute appendicitis, the pain usually starts around the navel region. The area in the lower right quadrant of the abdomen develops tenderness to pressure. The pain keeps worsening and becomes sharp in nature. Activities such as breathing deeply, walking, sneezing and coughing become very painful.

The pain and tenderness in the lower right quadrant of the abdomen increases significantly when the appendix bursts. In some cases, the bursting of the appendix may at first provide relief from the pain, but then the severe pain sets in. It is important to remember that severe abdominal pain by itself is not a symptom of a burst appendix. Other signs and symptoms must also be considered in order to reach a diagnosis.

Read more on appendix pain.

Recurrent nausea and vomiting

Nausea and vomiting are also common in appendicitis. The symptoms of nausea begin early in cases of acute appendicitis, and usually accompany the pain in the navel region. Vomiting may also occur. However, both nausea and vomiting tend to subside within a few hours.

Bursting of the appendix may again trigger intense nausea and vomiting, along with severe pain in the abdomen. Nausea and vomiting are also indicative of peritonitis. Since more than half the cases of appendicitis do not show the classical signs and symptoms of appendicitis, nausea and vomiting alone are not reliable indicators of a burst appendix.


Low-grade fever is usually one of the late-appearing signs of appendicitis. Bursting of the appendix may cause a sudden rise in the intensity of the fever, leading to body temperatures of 38.9 °C (102 °F) and above. Sometimes, the low grade fever may resolve on its own as the abdominal pain subsides. However, the fever can rise suddenly and should be taken as a serious sign even when other signs and symptoms seem to be stable. Chills may also occur when high grade fever sets in.

Signs of shock

The spilling of bacteria from the intestine into the sterile environment of the abdominal cavity can lead to peritonitis. This may progress to potentially fatal sepsis when the bacteria gain access to the bloodstream and spread throughout the body. The key signs of sepsis are high grade fever, rapid breathing, and a very rapid heart rate of more than 90 beats every minute.

Difficulty in breathing, alteration of mental status, and significantly decreased urine output indicate a worsening of the condition. Septic shock may then set it, resulting in a precipitous drop in blood pressure. The skin may also turn pale in color which is also considered to be a very dangerous sign.

Warning signs in children

It is particularly difficult to diagnose appendicitis in children. Kids may not be able to accurately describe their symptoms in case of appendicitis or a burst appendix. Children may not be able to localize the pain in the abdomen. Sometimes, even the pain sensation may not be obvious to them. This makes it necessary to look for other signs such as vomiting, rise in fever, and signs of septic shock. The affected child may also be irritable and show paleness of skin, abdominal swelling and abdominal tenderness.

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