What is Appendicitis?

Appendicitis is a painful swelling and infection of the appendix. Appendicitis is a medical emergency that requires immediate care. People who think they have appendicitis should see a doctor or go to the emergency room right away. Swift diagnosis and treatment reduce the chances the appendix will burst and improve recovery time.

What is the Appendix?

The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Scientists are not sure what the appendix does, if anything, but removing it does not appear to affect a person’s health. The inside of the appendix is called the appendiceal lumen. Mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine.

What Causes Appendicitis?

Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include:

  • Faeces, parasites, or growths that clog the appendiceal lumen
  • Enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
  • Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • Trauma to the abdomen

An inflamed appendix will likely burst if not removed. Bursting spreads infection throughout the abdomen a potentially dangerous condition called peritonitis.

Risk Factors – Who gets Appendicitis?

Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.

What are the symptoms of Appendicitis?

Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain. The abdominal pain usually:

  • Occurs suddenly, often causing a person to wake up at night
  • Occurs before other symptoms
  • Begins near the belly button and then moves lower and to the right
  • Is new and unlike any pain felt before
  • Gets worse in a matter of hours
  • Gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation or diarrhoea
  • Inability to pass gas
  • Low-grade fever that follows other symptoms
  • Abdominal swelling
  • The feeling that passing stool will relieve discomfort

Symptoms vary and can mimic other sources of abdominal pain, including:

  • Intestinal obstruction
  • Inflammatory bowel disease
  • Pelvic inflammatory disease and other gynaecological disorders
  • Intestinal adhesions
  • Constipation

How is Appendicitis Diagnosed?

A doctor or other health care provider can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. If a person shows classic symptoms, a doctor may suggest surgery right away to remove the appendix before it bursts. Doctors may use laboratory and imaging tests to confirm appendicitis if a person does not have classic symptoms. Tests may also help diagnose appendicitis in people who cannot adequately describe their symptoms, such as children or the mentally impaired.

Surgical Treatment

Surgery to remove the appendix is called appendicectomy. Laparoscopic surgery uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.

Surgery occasionally reveals a normal appendix. In such cases, many surgeons will remove the healthy appendix to eliminate the future possibility of appendicitis. Occasionally, surgery reveals a different problem, which may also be corrected during surgery.

Sometimes an abscess forms around a burst appendix called an appendiceal abscess. An abscess is a pus-filled mass that results from the body’s attempt to keep an infection from spreading. An abscess may be addressed during surgery or, more commonly, drained before surgery. To drain an abscess, a tube is placed in the abscess through the abdominal wall. CT is used to help find the abscess. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. Six to 8 weeks later, when infection and inflammation are under control, surgery is performed to remove what remains of the burst appendix.

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Laparoscopic Appendicectomy is performed under sterile conditions in the operating room with the patient under general anaesthesia. During laparoscopy, the patient is placed lying on their back with their body tilted so the feet are higher than the head. This position helps to move some of the abdominal organs toward the chest allowing the surgeon a clearer view.

The surgeon makes an incision over the abdomen and inserts a harmless gas into the abdominal cavity to expand the viewing area of the abdomen giving the surgeon a clear view and room to work.

The surgeon makes another incision and inserts a tube called a trocar through which the laparoscope is introduced into the abdomen. Additional small incisions may be made for a variety of surgical instruments to be used during the procedure. With the images from the laparoscope as a guide, the surgeon can look at the appendix and determine the extent of the problem.

A variety of surgical instruments can be inserted through the laparoscope or through other small incisions your surgeon may make to remove the appendix. Once the appendix is removed the area is washed with sterile fluid to minimise the risk of infection. After treating the problem, the laparoscope and other instruments are removed and the gas released.

The tiny incisions are closed and covered with small bandages. Laparoscopy is much less traumatic to the muscles and soft tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques).

Postoperative Guidelines

Common postoperative guidelines following laparoscopic appendicectomy include the following:

  • You will probably be in the hospital for a day or two, longer if the appendix ruptured.
  • Follow your surgeon’s instructions regarding the dressings on the incision sites.
  • Deep breathing and moving around after your surgery helps to prevent pneumonia.
  • Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon’s instructions for a successful recovery.
  • You may feel soreness around the incision areas. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable.
  • If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed.
  • Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain, or dizziness.

Risks and Complications

As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Most patients do not have complications after laparoscopic appendicectomy; however complications can occur and depend on which type of surgery your doctor performs as well as the patient’s health status. (Obese, diabetic, smoker, etc.). Complications can be medical (general) or specific to appendicectomy surgery. Medical complications include those of the anaesthesia and your general well-being. Almost any medical condition can occur so this list is not complete.

Complications include:

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Because the abdominal muscles are not cut in laparoscopic surgery, the pain and complications associated with abdominal surgery are lessened. However, complications can occur with any surgery. Specific complications for Laparoscopic Appendicectomy include:

  • Post-operative fever and infection
  • Surgical injury to blood vessels
  • Surgical injury to bowel or bladder
  • Gas Embolism
  • Blood Clots
  • Adhesions
  • Conversion to Open Appendicectomy

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