Elton John to Undergo Surgery for Appendicitis

Sir Elton John has been forced to cancel his upcoming concerts. The Rocket Man singer has been sidelined with appendicitis.

According to his reps:

Elton is incredibly disappointed to postpone these tour dates.To know that he made such super-human efforts and continued to perform to thousands through his illness only confirms his dedication to his European fans. He is eager to be back on top form and return to play the remaining shows starting in early September 2013.”

Elton had been feeling ill during his current European tour. He underwent a number of tests which eventually diagnosed an “appendix abscess surrounding retrocaecal appendicitis.”

John will need to undergo surgery to remove his appendix, but this can not be done until he completes an intensive course of antibiotics to “cool down” the infected site.

What is the appendix and what is appendicitis?

vermiform_appendixThe appendix is a hollow pouch, about the size and shape of your little finger, off the end of the large intestine, and in located in the right lower part of the abdomen.

The function of the appendix is unknown and its removal does not seem to cause any harm to a person’s health.

Appendicitis is an inflammation of the appendix when the opening of the pouch becomes obstructed, allowing germs to overgrow and cause an infection.

If left untreated, the appendix can become so swollen that it bursts open, allowing germs to spill out into abdominal cavity outside of the intestines (also known as the peritoneal cavity). This infection of the peritoneal cavity is a more dangerous condition, known as peritonitis.

Anyone can get appendicitis, but it is most common in people aged 10-30.

The classic signs and symptoms of appendicitis include:

  • Severe abdominal pain, typically starting around the umbilicus (belly button),then moving to the right lower abdomen as the disease progresses. Symptoms may progress over a period of 12-18 hours.
  • Fever
  • Nausea and/or vomiting
  • Diarrhea or constipation
  • Tenderness in right lower abdomen on examination, especially with “guarding” or ”rebound.” Guarding is a subconscious tightening of the abdominal muscles, even before the abdomen is touched. Rebound is when the pain is worse when an examiner hand lifts up than when the examiner presses down on the abdomen.
  • Movement of the leg in certain directions causes pain in the right lower abdomen (psoas and obturator signs).
  • There are other diseases whose symptoms can mimic appendicitis,  so examination by a doctor is essential.

appendix positionsAlthough the origin of the appendix is fairly constant (about an inch below the connection between the small and large intestine), the tip of the appendix can vary quite a bit. It can hide behind the first part of the large intestine (cecum) called a retrocecal (retrocaecal) appendix  or extend into the pelvis outside the peritoneal cavity.

Having appendicitis in a retrocecal appendix may be more difficult to diagnose.  The cecum, distended with gas, can protect the inflamed appendix from the pressure. Even deep pressure in the right lower abdomen may fail to provoke  tenderness – one of the important signs to doctors examining a patient for appendicitis.

A delay in diagnosis can cause the appendix to rupture, or to have intestinal content seep into the abdominal cavity near the appendix. This area may become “walled- off” to form an abscess.

Treatment of an appendiceal abscess may consist of nonsurgical (antibiotics) and/or surgical treatment options.

For more information about appendicitis, click here to go to the Resounding Health Casebook on the topic.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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