Acute Appendicitis &

Homeopathy
August 17, 2015
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by Rajneesh Kumar Sharma

Written by Rajneesh Kumar Sharma

Appendicitis is a common and urgent surgical illness with
variable manifestations, generous overlap with other
clinical syndromes, and significant morbidity. No single
sign, symptom, or diagnostic test accurately makes the
diagnosis of appendiceal inflammation in all cases. The
classic history of anorexia and periumbilical pain followed
by nausea, right lower quadrant (RLQ) pain, and vomiting
occurs in only 50% of cases.

Appendicitis is a common and urgent surgical illness

with variable manifestations, generous overlap with
other clinical syndromes, and significant morbidity,
which increases with diagnostic delay. No single sign,
symptom, or diagnostic test accurately makes the
diagnosis of appendiceal inflammation in all cases.

Acute Appendicitis
PATHOPHYSIOLOGY
Obstruction of the appendiceal lumen is the primary
cause of appendicitis (Homeopathy for Appendicitis).
Obstruction of the lumen leads to distension of the
appendix due to accumulated intraluminal fluid.
Ineffective lymphatic and venous drainage allows
bacterial invasion of the appendiceal wall and, in
advanced cases, perforation and spillage of pus into
the peritoneal cavity.

MORTALITY/MORBIDITY
Overall mortality rate of 0.2-0.8% is attributable to
complications of the disease rather than to surgical
intervention. Mortality rate rises above 20% in
patients older than 70 years, primarily because of
diagnostic and therapeutic delay. Perforation rates
are higher in patients younger than 18 years and in
patients older than 50 years, possibly because of
delays in diagnosis. Appendiceal perforation is
associated with an increase in morbidity and
mortality rates.
SEX
Incidence of appendicitis is approximately 1.4 times
greater in men than in women.

AGE
Incidence of appendicitis gradually rises from birth,
peaks in the late teen years, and gradually declines
in the geriatric years. Although rare, cases of
neonatal and even prenatal appendicitis have been
reported.

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HISTORY
Variations in the position of the appendix, age of the
patient, and degree of inflammation make the clinical
presentation of appendicitis notoriously inconsistent.
In addition, many other disorders present with
symptoms similar to those of appendicitis. These
include pelvic inflammatory disease (PID), tubo-
ovarian abscess, endometriosis, ovarian cyst or
torsion, degenerating uterine leiomyomata,
diverticulitis, Crohn disease, colonic carcinoma,
rectus sheath hematoma, cholecystitis, bacterial
enteritis, mesenteric adenitis, and omental torsion.

The classic history of anorexia and periumbilical pain

followed by nausea, right lower quadrant (RLQ) pain,
and vomiting occurs in only 50% of cases.

Migration of pain from the periumbilical area to the

RLQ is the most discriminating historical feature, with
sensitivity and specificity of approximately 80%.
When vomiting occurs, it nearly always follows the
onset of pain. Vomiting that precedes pain is
suggestive of intestinal obstruction, and the
diagnosis of appendicitis should be reconsidered.
Nausea is present in 61-92% of cases; anorexia is
present in 74-78% of cases. Diarrhea or constipation
is noted in as many as 18% of patients. Duration of
symptoms is less than 48 hours in approximately
80% of adults but tends to be longer in the elderly
and in those with perforation. Approximately 2% of
patients report duration of pain in excess of 2 weeks.
History of prior similar pain is reported in as many as
23% of cases.

An inflamed appendix located in proximity to the

urinary bladder or ureter can give rise to irritative
voiding symptoms and hematuria or pyuria.
Remember that cystitis in males is rare in the
absence of instrumentation. Consider the possibility
of an inflamed pelvic appendix in males with
apparent cystitis.

PHYSICAL EXAMINATION
RLQ (Right lower quadrant) tenderness is present in
96% of patients but is a very nonspecific finding. The
most specific physical findings are rebound
tenderness, pain on percussion, rigidity, and
guarding.

Rovsing sign (ie, RLQ pain with palpation of the LLQ),

obturator sign (ie, RLQ pain with internal rotation of
the flexed right hip), and psoas sign (ie, RLQ pain
with hyperextension of the right hip) are present in a
minority of patients with acute appendicitis. Their
absence never should be used to rule out
appendiceal inflammation.

A positive cough sign (ie, sharp pain in the RLQ

elicited by a voluntary cough) may be helpful in
making the clinical diagnosis of localized peritonitis.
Similarly, RLQ pain in response to percussion of a
remote quadrant of the abdomen, or to firm
percussion of the patient. The

literature is inconsistent as to whether rectal

examination is helpful in making the diagnosis;
however, failure to perform a rectal examination is
cited frequently in successful malpractice claims.

CAUSES
Appendicitis is usually precipitated by obstruction of
the appendiceal lumen. Causes of luminal
obstruction include fecaliths, lymphoid follicle
hyperplasia, foreign bodies (eg, shotgun pellet,
intrauterine device), and tumors. Fecoliths form
when calcium salts and fecal debris become layered
around a nidus of inspissated fecal material located
within the appendix.

Lymphoid hyperplasia is associated with a variety of

inflammatory and infectious disorders including
Crohn disease, gastroenteritis, amebiasis, respiratory
infections, measles, and mononucleosis.

DIFFERENTIALS
 Cholecystitis and Biliary Colic
 Constipation
 Diverticular Disease
 Endometriosis
 Gastroenteritis
 Inflammatory Bowel Disease
 Mesenteric Ischemia
 Ovarian Cysts
 Ovarian Torsion
 Pediatrics, Intussusception
 Pelvic Inflammatory Disease
 Spider Envenomations, Widow

LAB STUDIES
 Complete blood count
 C-reactive protein test
 Computed tomography
 Ultrasonography
 Abdominal radiography
 Barium enema
 Radionuclide scanning
 Clinical diagnostic scores – Diagnostic scoring is done by a
finite number of clinical variables which are elicited from the
patient and each is given a numerical value. The sum of these
values is used to predict the likelihood of acute appendicitis.

The best known of these is the MANTRELS score,

which tabulates presence or absence of migration of
pain, anorexia, nausea/vomiting, tenderness in the
RLQ, rebound tenderness, elevated temperature,
leukocytosis, and shift to the left.

 Computer-aided diagnosis – A retrospective database of

clinical features of patients with appendicitis and other causes
of abdominal pain is entered into a computer. It is then
utilized in prospectively assessing the risk of appendicitis.
Computer-aided diagnosis can achieve sensitivity greater than
90% while reducing rates of perforation and negative
laparotomy by as much as 50%.

TREATMENT of Acute Appendicitis

It includes the following-

EMERGENCY DEPARTMENT CARE

Treatment guidelines for patients with suspected

acute appendicitis include the following -Aggressive
crystalloid therapy to patients with clinical signs of
dehydration or septicemia. Restriction of anything by
mouth to patients with suspected appendicitis.
Consideration of ectopic pregnancy in women of
childbearing age and obtain a qualitative beta-hCG in
all cases.

Homeopathic Remedies for Acute Appendicitis

The goals of therapy are to eradicate the infection
and prevent complications.

Belladonna
TYLER- Medicine acute intest. conditions, colic
– Abdominal pains, violent; come and disappear
suddenly – squeezing; clawing; as if griped by nails;
violent pinchings. “Violent colic, intense cramping
pain, face red as fire.” Tenderness of abdomen, worst
least jar. Frequent urging to stool, little or no result
(Nux). Spasmodic contraction of sphincter ani. Great
pain in ileo-caecal region: cannot bear slightest
touch, even of bedclothes (early appendicitis. Local
external applications to abort). Typical Belladonna
has red, hot face; big pupils: is sensitive to pressure
draughts, jar.
TYLER – Special remedies of appendix and caecum
– Years ago, when making diagrams to show the
action of remedies on parts of the body, one grasped
the fact that two drugs seemed to share the honours
in this area- Belladonna and Mercurius corrosivus.
And one knows that Belladonna has earned a great
reputation for early, simple inflammation of
appendix. Among its symtoms are : Great pain in
right ileo-caecal region. Cannot bear the slightest
touch, not even of bed covers. Tenderness
aggravated by least jar.(KENT says, “The jar of the
bed will often reveal to you the remedy”). Belladonna
has much swelling. Its inflammations throb, feel
bursting. Kent also says, “There are instances where
Belladonna is the remedy of all remedies in
appendicitis”.
Mercurius corrosivus
TYLER – Medicine acute intest. conditions, colic. -
Peculiar bruised sensation about caecum and along
transverse colon. Tender to pressure. Appendicitis.
(Bell). Painful bloody discharges (from rectum) with
vomiting. Tenesmus, persistent, incessant, with
insupportable cutting, colicky pains. Diarrhoea
dysentery with terrible straining before, with, and
after stool. Mercurius cor. is almost specific for
dysentery. Very distressing tenesmus, getting worse
and worse: nothing blood.
TYLER – Special remedies of appendix and caecum –
Kent has this drug down in black type for
appendicitis. Mercurius corr. is violent and active.
Has far more activity, excitement and burning.
Caecal region and transverse colon painful. Bloated
abdomen. Characteristic: Great tenesmus of rectum,
the “never-get-done” remedy. Abdomen bruised,
bloated, tender to least touch. Tenesmus of bladder,
also. Hot urine passed drop by drop.
Bryonia alba
TYLER – Special remedies of appendix and caecum
– Appendicitis : peritonitis. Must keep very still; stools
hard, dry, as if burnt. Pain in a limited spot : dull,
throbbing or sticking. Bryonia is better lying on
painful side, from pressure and to limit movement.
Lies knees drawn up. Better for heat to inflamed part.
Echinacea purpurea
TYLER – Special remedies of appendix and caecum –
(In Repertory for Appendicitis). Boericke says : “It
acts on appendix and has been used for appendicitis.
But remember, it promotes suppuration, and a
neglected appendix with pus formation would
probably rupture sooner under its use”. –
BOERICKE – Lymphatic inflammation; crushing
injuries. Compare : Iris florentina-Orris-root-(delirium,
convulsions, and paralysis); Iris factissima (headache
and hernia); Iris germanica-Blue Garden Iris-(dropsy
and freckles); Iris tenax -1.minor-(dry mouth; deathly
sensation at point of stomach, pain in ileo-caecal
region; appendicitis. Pain from adhesions after).
CLARKE -Echinacea angustifolia – Clinical –
Appendicitis.
Natrium sulphuricum
BORLAND – Digestive drugs – Apparently, it is a
retro-cecal appendix, because they always complain
of extreme pain going right round to the back, rather
than of pain of McBurney’s Point. It is the type of
appendix which is associated with a degree of
jaundice. Some of the most striking results from
Natrum sulph. have been in cases of appendix
abscesses, where there has been a retro-cecal
appendix and a tendency for the inflammation to
track up and conditions suggesting a sub-phrenic.
There is one other rather interesting point about this
remedy, and it has no connection with the digestive
system. Natrum sulph. is sometimes very well
indicated in acute hip joints, particularly when it is
the right hip which is affected. The pain is very
similar in character to that experienced in cases of
appendicitis, and if there are any Natrum sulph.
indications, it is worthwhile to consider its use. Two
cases in hospital cleared up remarkably well on
Natrum sulph., and it is apt to be forgotten for this
condition.
KENT – Natrium sulphuricum – It has cured many
cases resembling the first stage of appendicitis. Pain
and tenderness in the whole abdomen. Flatulence;
colic; rending, tearing, cutting pains throughout the
abdomen; stitching pains in the abdomen; violent
neuralgic pains in the abdomen; inflammation of the
bowels, of the peritoneum; appendicitis.
Arnica Montana
KENT – Do not forget the symptoms of Arnica in
appendicitis if you know Bryonia, Rhus tox.,
Belladonna, Arnica and similar remedies. The
homoeopathic remedy will cure these cases, and, if
you know it, you need never run after the surgeon in
appendicitis except in recurrent attacks. If you do not
know your remedies, you will succumb to the
prevailing notion that it is necessary to open the
abdomen and remove the appendix. It is only
deplorable ignorance that causes appendicitis to be
surrendered to the knife.
“Great pain in the ileo-caecal region; cannot bear the
slightest touch, even the bed clothes.”

Alfalfa
BOERICKE- Abdomen – Flatulence with distention.
Shifting, flatulent pain along colon several hours
after meals. Frequent, loose, yellow, painful stools,
with burning of flatulence. Chronic appendicitis.
Cascara sagrada
BOERICKE – Relationship – Compare : Hyd.; Nux.;
Rhamnus Californica (tincture for constipation;
tympanites and appendicitis and especially
rheumatism). Acts on vermiform appendix. Thus has
been used for appendicitis, but remember it
promotes suppuration and a neglected appendicitis
with pus formation would probably rupture sooner
under its use.
Ammoniacum gummi
CLARKE -clinical- Appendicitis. Stitches in the caecum
at 7 p.m., alternating with pains elsewhere. This
should make it appropriate in some cases of
appendicitis. As an external application in the form of
compresses, Lime-water has an ancient repute in
allaying inflammation of many kinds.
Calcarea caustica
CLARKE –Characteristics – It has rapidly dispelled all
inflammatory action in cases of appendicitis; and has
removed all suffering in an aggravated case of
phagedaenic piles.
Lachesis mutus
CLARKE – – Clinical – Appendicitis. Acute pain in liver
extending towards stomach,” though contrary to the
general “left to right” direction, is characteristic, as I
can testify. Lachesis is also one of the most
prominent remedies in appendicitis.
Scrophularia marylandica
CLARKE – Clinical. – Appendicitis. Breast, tumours of.
Colic. Colic just below navel and some griping in the
side in afternoon. Griping below navel, 7 a.m. (after a
slight vexation). Pain in sigmoid flexure. Dull, heavy,
periodic pain < when abdomen compressed, legs
extended. (Appendicitis as a local remedy. – R. T. C.).
Several stools daily with tenesmus. Albuminuria.
Tuberculinum bovinum kent
CLARKE – Clinical. – Appendicitis. “Sensitive to
music” was observed in one of Nebel’s patients;
another had pains in the region of the appendix
vermiformis, which should lead to serviceable action
in appendicitis cases.
Phosphorus
KENT – Yellow, brown spots on the abdomen;
petechiae over the abdomen during typhoid fever.
Pale face in pleura/peritoneum-disease, red face in
articular affections.

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