In men, appendicitis usually begins with a cramping wave-like mid-abdominal pain, that after number of hours, usually within a day, the pain is then localized in the right lower side of the abdomen.
The cramping pain is because the appendix is being blocked by a concretion, a solid mass of feces, and that cramping pain is caused by the contractions of the appendix trying to push it out.
But once the block remains, the protein mucus (germ food) in the appendix allows the bacterial germs proliferate. This causes the appendix to become inflamed from acute infection. And that infected appendix touching the inside of the abdominal cavity, its peritoneal lining’s thousands of tiny nerves, causes the localized pain.
In a woman, it is the exact same situation with appendicitis. However, making the correct diagnosis is complicated by the possibility of the infection being caused instead by pelvic inflammatory disease, usually caused by the bacterial germ gonorrhea, infecting the fallopian tubes. Here instead of a low-grade fever of approximately 100°, it’s usually between 102° to 103°. During a pelvic examination, by pushing on the mouth of the womb, the cervix, this causes severe pain. That helps distinguish between appendicitis versus infected fallopian tube‘s.
In children, the sequence of events is much faster, usually within 12 hours to one day until the rupturing of the appendix occurs. And unlike in adults, the omentum, the fat pad that hangs down from the stomach and large intestine is much less developed, and therefore infection can spread throughout the abdominal cavity, which is called peritonitis. In adults, it’s more likely that this fat pad will wall off and then localize the infection causing an abscess, rather than a widespread and potentially deadly infection, peritonitis.