11 Facts About the Appendix

Illustration by Mental Floss / Images: iStock
Illustration by Mental Floss / Images: iStock

Despite some 500 years of study, the appendix might be one of the least understood structures in the human body. Here's what we know about this mysterious organ.

1. THE ANCIENT EGYPTIANS CALLED IT THE "WORM" OF THE BOWEL.

The human appendix is small, tube-shaped, and squishy, giving ancient Egyptians, who encountered it when preparing bodies for funerary rites, the impression of a worm. Even today, some medical texts refer to the organ as vermiform—Latin for "worm-like."

2. THE APPENDIX SHOWS UP IN LEONARDO DA VINCI’S DRAWINGS.

The earliest description of a human appendix was written by the Renaissance physician-anatomist Jacopo Berengario da Carpi in 1521. But before that, Leonardo da Vinci is believed to drawn the first depiction of the organ in his anatomical drawings in 1492. Leonardo claimed to have dissected 30 human corpses in his effort to understand the way the body worked from mechanical and physiological perspectives.

3. IT'S ABOUT THE SIZE OF A PINKY FINGER.

The appendix is a small pouch connected to the cecum—the beginning of the large intestine in the lower right-hand corner of your abdomen. The cecum’s job is to receive undigested food from the small intestine, absorb fluids and salts that remain after food is digested, and mix them with mucus for easier elimination; according to Mohamad Abouzeid, M.D., assistant professor and attending surgeon at NYU Langone Health, the cecum and appendix have similar tissue structures.

4. CHARLES DARWIN THOUGHT IT WAS A VESTIGIAL ORGAN …

The appendix has an ill-deserved reputation as a vestigial organ—meaning that it allegedly evolved without a detectable function—and we can blame Charles Darwin for that. In the mid-19th century, the appendix had been identified only in humans and great apes. Darwin thought that our earlier ancestors ate mostly plants, and thus needed a large cecum in which to break down the tough fibers. He hypothesized that over time, apes and humans evolved to eat a more varied and easier-to-digest diet, and the cecum shrank accordingly. The appendix itself, Darwin believed, emerged from the folds of the wizened cecum without its own special purpose.

5. … BUT THE APPENDIX PROBABLY EVOLVED TO HELP IMMUNE FUNCTION.

The proximity and tissue similarities between the cecum and appendix suggest that the latter plays a part in the digestive process. But there’s one noticeable difference in the appendix that you can see only under a microscope. “[The appendix] has a high concentration of the immune cells within its walls,” Abouzeid tells Mental Floss.

Recent research into the appendix's connection to the immune system has suggested a few theories. In a 2015 study in Nature Immunology, Australian researchers discovered that a type of immune cells called innate lymphoid cells (ILCs) proliferate in the appendix and seem to encourage the repopulation of symbiotic bacteria in the gut. This action may help the gut recover from infections, which tend to wipe out fluids, nutrients, and good bacteria.

For a 2013 study examining the evolutionary rationale for the appendix in mammal species, researchers at Midwestern University and Duke University Medical Center concluded that the organ evolved at least 32 times among different lineages, but not in response to dietary or environmental factors.

The same researchers analyzed 533 mammal species for a 2017 study and found that those with appendices had more lymphatic (immune) tissue in the cecum. That suggests that the nearby appendix could serve as "a secondary immune organ," the researchers said in a statement. "Lymphatic tissue can also stimulate growth of some types of beneficial gut bacteria, providing further evidence that the appendix may serve as a 'safe house' for helpful gut bacteria." This good bacteria may help to replenish healthy flora in the gut after infection or illness.

6. ABOUT 7 PERCENT OF AMERICANS WILL GET APPENDICITIS DURING THEIR LIFETIMES.

For such a tiny organ, the appendix gets infected easily. According to Abouzeid, appendicitis occurs when the appendix gets plugged by hardened feces (called a fecalith or appendicolith), too much mucus, or the buildup of immune cells after a viral or bacterial infection. In the United States, the lifetime risk of getting appendicitis is one in 15, and incidence in newly developed countries is rising. It's most common in young adults, and most dangerous in the elderly.

When infected, the appendix swells up as pus fills its interior cavity. It can grow several times larger than its average 3-inch size: One inflamed appendix removed from a British man in 2004 measured just over 8 inches, while another specimen, reported in 2007 in the Journal of Clinical Pathology, measured 8.6 inches. People with appendicitis might feel generalized pain around the bellybutton that localizes on the right side of the abdomen, and experience nausea or vomiting, fever, or body aches. Some people also get diarrhea.

7. APPENDECTOMIES ARE ALMOST 100 PERCENT EFFECTIVE FOR TREATING APPENDICITIS.

Treatment for appendicitis can go two ways: appendectomy, a.k.a. surgical removal of the appendix, or a first line of antibiotics to treat the underlying infection. Appendectomies are more than 99 percent effective against recurring infection, since the organ itself is removed. (There have been cases of "stump appendicitis," where an incompletely removed appendix becomes infected, which often require further surgery.)

Studies show that antibiotics produce about a 72 percent initial success rate. “However, if you follow these patients out for about a year, they often get recurrent appendicitis,” Abouzeid says. One 2017 study in the World Journal of Surgery followed 710 appendicitis patients for a year after antibiotic treatment and found a 26.5 percent recurrence rate for subsequent infections.

8. AN INFECTED APPENDIX DOESN’T ACTUALLY BURST.

You might imagine a ruptured appendix, known formally as a perforation, being akin to the "chestbuster" scene in Alien. Abouzeid says it's not quite that dramatic, though it can be dangerous. When the appendix gets clogged, pressure builds inside the cavity of the appendix, called the lumen. That chokes off blood supply to certain tissues. “The tissue dies off and falls apart, and you get perforation,” Abouzeid says. But rather than exploding, the organ leaks fluids that can infect other tissues.

A burst appendix is a medical emergency. Sometimes the body can contain the infection in an abscess, Abouzeid says, which may be identified through CT scans or X-rays and treated with IV antibiotics. But if the infection is left untreated, it can spread to other parts of the abdomen, a serious condition called peritonitis. At that point, the infection can become life-threatening.

9. SURGEONS CAN REMOVE AN APPENDIX THROUGH A TINY INCISION.

In 1894, Charles McBurney, a surgeon at New York's Roosevelt Hospital, popularized an open-cavity, muscle-splitting technique [PDF] to remove an infected appendix, which is now called an open appendectomy. Surgeons continued to use McBurney's method until the advent of laparoscopic surgery, a less invasive method in which the doctor makes small cuts in the patient's abdomen and threads a thin tube with a camera and surgical tools into the incisions. The appendix is removed through one of those incisions, which are usually less than an inch in length.

The first laparoscopic appendectomies were performed by German physician Kurt Semm in the early 1980s. Since then, laparoscopic appendectomies have become the standard treatment for uncomplicated appendicitis. For more serious infections, open appendectomies are still performed.

10. AN APPENDIX ONCE POSTPONED A ROYAL CORONATION.

When the future King Edward VII of Great Britain came down with appendicitis (or "perityphlitis," as it was called back then) in June 1902, mortality rates for the disease were as high as 26 percent. It was about two weeks before his scheduled coronation on June 26, 1902, and Edward resisted having an appendectomy, which was then a relatively new procedure. But surgeon and appendicitis expert Frederick Treves made clear that Edward would probably die without it. Treves drained Edward's infected abscess, without removing the organ, at Buckingham Palace; Edward recovered and was crowned on August 9, 1902.

11. THE WORLD'S LONGEST APPENDIX MEASURED MORE THAN 10 INCHES.

On August 26, 2006, during an autopsy at a Zagreb, Croatia hospital, surgeons obtained a 10.24-inch appendix from 72-year-old Safranco August. The deceased currently holds the Guinness World Record for "largest appendix removed."

10 Smart Facts About Your Gut

Colorized scanning electron micrograph of E. coli, a common gut bacteria
Colorized scanning electron micrograph of E. coli, a common gut bacteria
National Institute of Allergy and Infectious Diseases, Flickr // CC BY 2.0

Gut feelings get all the press, but your gut may be more of a thinker than you know. Some scientists now consider it a second brain. While it won’t necessarily help you study for an exam or get a promotion, your gut can influence the chemistry of your mood, emotions, immune system, and long-term health. Research even suggests the gut can “learn” new tricks through conditioning. These powerful connections are part an emerging field of science called neurogastroenterology designed to study the gut-brain link. Here are 10 facts you may not know about your gut.

1. THE GUT DOESN'T NEED THE BRAIN'S INPUT. 

You might think of your gut as a rebel against authority. It doesn’t wait for your brain’s impulses to do the important work of digestion, because it doesn’t need to—it acts as its own “brain.” No other organ, not even the all-powerful heart, can pull that off.

2. THERE ARE MORE THAN 100 MILLION BRAIN CELLS IN YOUR GUT.

Your gut’s power to think for itself is no surprise; there are millions of neurons in its lengthy coils (9 meters of intestines, from esophagus to anus). That’s more neurons than are found in the spinal cord or peripheral nervous system.

3. YOUR GUT HAS ITS OWN NERVOUS SYSTEM.

The enteric nervous system—the controlling mechanism of digestion and elimination—is the overlord of your gut, and functions all on its own. Some scientists see it as part of the central nervous system, while others consider it its own entity. It likely evolved to give the gut the go-ahead when the “got to go” impulse strikes, without requiring the brain’s sign-off, particularly when you consider the helplessness of an infant with its brand-new brain.

4. THERE'S AN INFORMATION HIGHWAY FROM YOUR GUT TO YOUR BRAIN.

There’s one big visceral nerve embedded in your gut—the vagus nerve. Research has revealed that up to 90 percent of its fibers carry information from the gut to the brain, rather than the other way around. In other words, the brain interprets gut signals as emotions. So you really should trust your gut.

5. MOST OF YOUR SEROTONIN IS IN YOUR GUT.

Some 95 percent of your body’s serotonin, that marvelous mood molecule that antidepressant drugs like Prozac keep in your body, can be found in the gut. So, it’s no wonder that diet, medications, and antibiotics can wreak havoc on one’s mood.

6. A HEALTHY GUT MAY PROTECT YOUR BONES.

In a study of the serotonin-gut relationship, scientists discovered an unexpected link between the gut and the bones. Inhibiting the gut’s release of serotonin counteracted the bone-density reduction of osteoporosis in mice. This research is going into studies on new osteoporosis-fighting drugs.

7. RESEARCH SHOWS LINKS BETWEEN AUTISM AND HAVING FEWER STRAINS OF GUT BACTERIA. 

In as many as nine out of 10 cases, autistic people have common gut imbalances such as leaky gut syndrome, irritable bowel syndrome, and fewer strains of “good” bacteria. Research on mice is looking at possible treatments of some of the behavioral disorders of autism by balancing microbes in the guts, though many warn that such treatments can’t produce a “cure” for autism.

8. FOOD REALLY DOES AFFECT YOUR MOOD. 

Different foods, when introduced to the gut via feeding tubes, have been shown to change a person's moods without the person’s awareness of what they were "eating." Fat, for instance, increased feelings of happiness and pleasure (no surprise there) because appeared to trigger the release of dopamine—the brain’s natural opiate. Carbohydrate consumption stimulated the release of serotonin, the “feel good” neurotransmitter.

9. YOUR GUT IS YOUR BEST FRIEND IN COLD AND FLU SEASON.

Not only does your gut hold brain cells, it also houses the bulk of your immune cells—70 percent—in the form of gut associated lymphoid tissue, or GALT, which plays a huge part in killing and expelling pathogens. GALT and your gut microbiome—the trillions of bacteria that live, like an immense microbial universe, in your gut—work hard to help you get over what ails you. That’s all the more reason to be careful with the use of antibiotics, which wipe out the good bacteria along with the bad.

10. YOUR GUT CAN BECOME ADDICTED TO OPIATES.

Inside your gut are opiate receptors, which are also found in the brain. The gut is just as susceptible to addiction as the brain and may contribute to the intense difficulty some addicts have trying to kick the habit.

What Causes Hiccups?

iStock/damircudic
iStock/damircudic

The cause of hiccups depends on whom you ask. The ancient Greek physician Galen thought hiccups were violent emotions erupting from the body, while others thought they were a sign of liver inflammation. Today, evidence points to spasms in the diaphragm, the large muscle between the chest and abdomen that aids airflow during breathing. This involuntary contraction can be brought on by a number of things that might irritate the nerves that control the movement of the muscle. A full stomach, heavy boozing, rapid shifts in temperature either inside or outside of the stomach, and certain emotions like shock or excitement are all common culprits.

No matter the cause, the result is the same: The diaphragm spasms and causes us to take a quick breath. The sudden rush of air causes the epiglottis (the flap that protects the space between the vocal cords) to shut and interrupt the breath, which makes the familiar "hic" sound.

WHAT CURES THEM?

The best cure for hiccups also depends on the person you ask. Almost all cures are based on one of two principles: One type works its magic by overwhelming the vagus nerve with another sensation. The vagus nerve is a cranial nerve that innervates the stomach and conveys sensory information about the body's organs to the brain. When distracted by overwhelming information of another sort, it basically tells the brain that something more important has come up and the hiccuping should probably be stopped (vagus nerve stimulation is also used to control seizures in epileptics and treat drug-resistant cases of clinical depression). The other method for curing hiccups is to interfere with the breathing, increasing the amount of carbon dioxide in the blood, and causing the body to focus on getting rid of the of the CO2 and not making hiccups.

Swallowing a spoonful of sugar is probably the most commonly prescribed hiccup cure and falls into the first category. A teaspoon of sugar is usually enough to stimulate the vagus nerve and make the body forget all about the hiccups. Even ardent supporters of the sugar cure disagree if the sugar should be taken dry or washed down with water, though.

If this home remedy doesn't work, and your hiccups are both severe and persistent, you may need to bring out the big guns. For chronic cases like this, doctors sometimes use a cocktail of Reglan (a gastrointestinal stimulant) and Thorazine (an anti-psychotic with sedative properties) to quiet things down. In some cases that resist these drugs, Kemstro, an anti-spasmodic, is also used. Other doctors have used vagus nerve stimulators implanted in the upper chest of patients. The pacemaker-like devices send rhythmic bursts of electricity through the vagus nerve to the brain to keep the hiccup cycle in check.

Many people prefer home remedies to battle their hiccups, which may include holding your breath, gargling ice water, or breathing into a paper bag. While the same people will swear by the treatment they've been using all these years, there's no firm scientific consensus that any of them actually work. But if it helps you, isn't that all that matters?

Have you got a Big Question you'd like us to answer? If so, let us know by emailing us at bigquestions@mentalfloss.com.

An earlier version of this article appeared in 2012.

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