What is appendicitis, and what could Joel Embiid’s recovery look like?

Joel Embiid had surgery on Thursday evening in Houston for appendicitis, potentially sidelining the Sixers star just before the playoffs.

Appendicitis affects up to 300,000 American adults a year, and about 8% of men on average.

David Stein, surgeon-in-chief at Temple University Hospital, spoke to The Inquirer about how the appendix works, how appendicitis manifests, and what recovery looks like.

The appendix is a small organ attached to the cecum, the first part of the colon.

For years, the appendix was considered vestigial — an unnecessary organ. But research in the last few decades has shown that the appendix serves important purposes.

It contains immune cells that help to make antibodies and fight off invaders in the body, and also serves as a reservoir for “good bacteria,” or the body’s microbiome, Stein said.

“If the colon’s bacteria gets screwed up, we have a reservoir to repopulate it as needed.”

That said, patients can live normally without an appendix.

Think of the appendix like an “animal balloon,” Stein said: “A long, wormy thing that has one opening.”

For people in their 20s and 30s, appendicitis is typically caused by an illness that leads to inflammation of lymphatic tissues, swelling the appendix’s opening shut. For older adults, appendicitis generally occurs when stool blocks the appendix opening.

Bacteria trapped in the appendix can cause further inflammation and infection, according to the Mayo Clinic. If left untreated, the appendix can burst, causing more serious health complications that are potentially life-threatening.

Typically, patients with appendicitis start feeling symptoms over the course of about 24 hours, Stein said. Embiid reported stomach pain to his doctors around 3 a.m. on Thursday and was in surgery by 5:30 p.m.

“As time goes on, the pain goes from being vague to a specific spot, around the right side of belly button and half an inch down,” Stein said. “People usually get more and more uncomfortable. They don’t want to eat, they don’t want to move.”

Doctors use a CT scan to diagnose appendicitis and treat it as quickly as possible. “For uncomplicated appendicitis, you see it, you book the operating room, you go to surgery. You don’t really delay,” Stein said.

Increasingly, doctors are treating appendicitis with a course of antibiotics over several days, as long as the appendix hasn’t ruptured. About 60 to 70% of people treated with only antibiotics improve without surgery, though they have to stay in the hospital for the duration of the treatment. If they don’t show improvement, surgery is the only option.

Surgeries are minimally invasive with a few small incisions on the abdomen.

People with desk jobs are usually back at work in “a couple weeks,” Stein said. But people with strenuous, physically demanding jobs — like a professional athlete — might need longer to return to work.

And recovery time can be longer with a ruptured appendix. New York Knicks forward OG Anunoby, who underwent an emergency appendectomy in early April 2019 while playing for the Toronto Raptors, was only cleared to return to play in Game 2 of the NBA Finals, nearly a month and a half later. He did not end up playing and later said that his appendix had ruptured before surgery, complicating his recovery.

(Coincidentally, Sixers head coach Nick Nurse was coaching the Raptors at the time.)

Without a rupture, a three-week recovery period would likely be the soonest Embiid could return to play, said Stein, who is not treating the Sixers center.

“Usually, patients are out a month,” Stein said. “I’d hope maybe it’s not the full month, maybe he could come back a little sooner. But that’s a fan talking.”

Doctors are particularly careful with recovery from appendicitis because they want to avoid patients disrupting abdominal incisions and risking a hernia.

“It’s probably best to let it really heal,” said Stein.