PSA: Complicated appendicitis

Initially written starting Wed Mar 18 23:58:02 UTC 2026 by Ellenor Bjornsdottir (she)

I don’t have time for a story, just give me the key takeaway.

If you have world-ending abdominal pain, and then you don’t, and you have a fever both times, you may have a ruptured appendix, which is a medical emergency. IV contrast is extremely unpleasant, but advocate hard for a CT scan and make sure to emphasise the concern that you may have appendicitis, and the world-ending abdominal pain you were in. It will save your life. Whether you need surgery or it turns out you only need antibiotics because you have appendicitis but it’s not necrotic or ruptured, you will get the treatment you need faster if you advocate for computer tomography. The radiation load is about the same as a transatlantic flight. Would you fly transatlantic to save your life?

If you end up needing a radical surgery like we did, it is possible that your terminal ileum has been removed; in such a case, you need vitamin B12 injections, or high dose sublingual, indefinitely (that is to say, until you die). If you do this you will probably lead a normal length of life, and die at a completely normal age never having known the agony of cobalamin deficiency (or if you had, but had corrected it since, never having returned to that agony). We hope we can be just as privileged.

Introduction

We write this recovering at home from open abdominal surgery, more specifically from «open appendectomy and ileocolic resection», with a diagnosis of «significant necrotic and perforated appendix with abscess formation and erosion into the terminal ileum.»

On the 28th of February, or maybe the 1st of March, we aren’t sure quite which because of timezones, a slow-motion bomb started going off in our abdomen. Let’s take a look at my symptom evolution. We’ll use the 28th as the start point, the 8th as the day I first went to the ER, and the 10th as the day I showed up, ambulatory but very sick, in an ambulance. The entire article will be written in a chaotic mixture of the 1st person singular and plural. “I” could mean somebody other than me, Ellenor Bjornsdottir, with whom I do however share a body. (In the days before the 10th it will likely mean Amelia, the drgn.)

28th of February

It’s the 28th of February, and I am suddenly coming down with a strange twinge of ?constipation. It’s whatever, right, these things happen. We’re no stranger to horribly stopped-up bowels. Same day, I think, we’re bedridden, moaning and writhing in pain that would merit even a morphine injection.

2nd of March

Records start to become clearer today, the 2nd of March. We had a very high heart rate and a weak (hard to measure wth a pulse oximeter) pulse, but were ambulatory and 3x oriented. By now we were drinking oral rehydration solution to try to counteract “dehydration”.

4th of March

Symptoms lessen somewhat. This is a common sign of a ruptured appendix. By now we’re wavering on whether we’re really sure this is appendicitis.

On this day and maybe before, we measure a 38°C fever. We assume this has been going on since the 28th, and start the process of mustering the executive function to drive us to the ER.

8th of March

BC adopts permanent PDT.

We go to the ER, I don’t know precisely when, are triaged to a low priority, and are seen by a doctor, EKG’d, some bloodwork is done. Findings: high white cells. Go home and keep taking ORS. We did not advocate forcefully enough for CT imaging of our appendix because we didn’t want to fuck around with the contrast.

9th of March

We experience a sort of PEM crash (we aren’t predisposed to PEM, so that’s novel…), and shit ourself after trying to sleep. (Specifically we thought we were going to fart, which is always difficult for us, and ended up, er, painting part of our bed.)

Something just instinctively tells us, this is serious.

10th of March

At some point we call 911 and describe our symptoms. The operator agrees an ambulance is indicated and sends one. We board, after packing for an anticipated long stay, and are taken in, directly admitted. At some point, IV access is achieved, probably to resuscitate us with fluids, as we are still very tachy (although we had high, not low blood pressure), and were wearing our respirator, so voluntary NPO. I don’t remember exactly the course of events, but we were given ketorolac for pain and eventually hydromorphone, both via the IV. The hydromorphone was weird, it seemed to cause us to fall asleep, and then we came around in a mostly-painless daze.

Dates get a bit blurry from here

At some point the IV in our arm is repurposed to give us contrast to do a CT scan on us. The injection process of that is very unpleasant. Beats dying of appendicitis though…

Ultimately we were found to probably need surgery. We were put on an antibiotic IV and done bloodwork every so often. Apparently our numbers keep going up.

11th or 12th of March

Section written by Reinhilde, starting Sat Mar 28 11:27:48 UTC 2026

At some point, we’re operated upon. Evidently (as Ellie wakes up with an incision for open surgery) it was necessary to convert from laparoscopic to open. I think she sort of expected this. As soon as she has properly come around she puts her respirator back on (it had to be taken off as we would not be breathing under our own power)

They continue the antibiotics infusions.

30th of March (UTC, anyway)

Section written by Reinhilde, starting Mon Mar 30 09:10:36 UTC 2026

By now, we’re only very intermittently using our prescribed painkillers, mostly because they’ve started causing us gut pain. (Yes, really. They’re opioids, our guts have been rearranged, opioids slow down the guts. The way we’ve been rearranged means that that is very, very painful if we need to take a shit.)

We learn more about ileocolic resection and ileocecal resection. In most cases, the terminal ileum is removed. The terminal ileum is responsible for absorbing vitamin B12 and reabsorbing bile acids. The result? A lot of people who have such procedures, usually for Crohn’s, have chronic diarrhea. For us, it’s pretty early days.