Sir Elton John’s complex appendicitis diagnosis explained

This week, a spokesperson for Sir Elton John confirmed that the singer was postponing a series of concerts on his European tour because he was suffering from appendicitis. The specific diagnosis, as given on John’s website, was “appendix abscess surrounding retrocaecal appendicitis.”

We’re about to get into the science of exactly what that diagnosis means, but first a warning: It’s not going to be pretty.

The appendix is attached to a part of your body called the cecum, which is a sack generally considered to be the beginning of your lower intestine. We’re going to have to talk about pus and catheters and kind of gross infections.

But if you think you can handle it, keep reading.

Everyone’s appendix is attached to the cecum, but individual appendixes can point in different directions. Some people’s appendixes point down toward the pelvis, others point straight out. John’s appendix does something a bit unusual in that it makes a U-turn and winds up hiding behind the cecum itself. That’s why it’s called “retrocaecal,” explained Dr. Jerald Wishner, co-director of robotic and minimally invasive surgery at Northern Westchester Hospital in New York.

This is actually good news for the 66-year-old Sir Elton. Based on the limited information on the singer’s website, Dr. Wishner said, it’s likely that John was having some discomfort, but probably not the acute pain that we associate with most cases of appendicitis.

When his appendix ruptured, the infection did not move into the intestine lining like it would have if the appendix had been pointing down; instead, the infection brewed where the appendix was sandwiched between the back of his abdomen and the cecum, creating a collection of pus.

This is when the pain probably became more severe. Doctors can’t go in and remove the appendix with all that infection and inflammation around it, so they will give John a course of antibiotics to treat the infection and will insert a catheter in the abscess to drain it.

Wishner said in cases like this, the catheter is usually needed for as little as a day or up to a week, and that it usually takes four to six weeks to get the infection under control. Once the area around the appendix is healthy again, doctors will remove the appendix in a surgery that requires just three small incisions. Most patients are able to go home the same day.

John’s website notes that he is following doctors orders and won’t continue to play shows until he has fully recovered.