Appendicitis: A surgical emergency
by ranali perera
The appendix is a small, worm-like, blind-ending hollow organ found at the junction between the large and small intestines. It is usually 8-10 cm long (but can be as long as 20 cm) and has no major role to play in the human body functions. While it is a non-essential organ present within our body, it does however, very frequently give rise to a condition called appendicitis.
Appendicitis is the inflammation of the appendix. It is a common cause of sudden onset abdominal pain and is considered an emergency situation. It is frequent among children and young adults and shows a slight male predisposition. A diet devoid of fibre has been shown to be one risk factor for the development of this condition.
The appendix is commonly found in right lower abdomen. However, in certain people the appendix would be located differently. Some common locations are in the pelvic cavity, behind the large intestine and under the liver.
How does the appendix get inflamed?
The main reason for the onset of appendicitis seems to be obstruction. The appendix can get obstructed due to stools (especially in the elderly), infection by bacteria (common cause in children and young adults), worm infestations (in those living in Eastern countries) and foreign bodies.
Once the appendix gets obstructed, the intestinal bacteria present within it will continue to grow. The inflammation can lead to swelling and impingement of nearby nerves and structures leading to pain. The blood supply can get obstructed with the swelling and the ischaemic condition can lead to the death of tissues.
This will lead to eventual rupture of the appendix.
What symptoms point towards a diagnosis of appendicitis?
The typical presentation is an initial on and off pain near the belly button that is later increased in severity and becomes more constant and felt on the lower abdomen of the right hand side
The pain would increase on coughing and with movement
This pain would be preceded by loss of appetite
Vomiting may be present with the severe abdominal pain
Fever and malaise
Diarrhoea or constipation
A classical presentation, however, is seen only in 50% of the patients.
Most often a doctor would be able to diagnose appendicitis by the clinical presentation. If the diagnosis is unclear, you may be required to take certain tests to confirm the diagnosis.
Pregnancy test in women of childbearing age to exclude a pregnancy
Urine tests to exclude conditions like urine infection
What complications can arise with this condition?
The bacterial infection within the closed-off appendix can lead to abscess formation with collection of pus (yellowish liquid consisting of immune cells and cell debris)
As the appendix gets swollen due to inflammation, it can rupture. This is a life-threatening situation.
The appendix harbours bacteria that would then be released onto the abdominal cavity. This can give rise to a condition called peritonitis.
If the bacteria enters the blood stream, it can lead to sepsis, shock and death.
The infection can sometimes spread to the ovaries and fallopian tubes in women, and lead to scarring and infertility.
The pain may reduce as the appendix ruptures. However, it will come back more severely along with high fever if peritonitis develops. Other symptoms that can be present with peritonitis include increase in heart rate and rapid shallow breathing.
How can you treat appendicitis and avoid development of complications?
As I mentioned before, the appendix isn't a vital organ. Therefore, the mainstay of treatment is surgery. This surgical removal of the appendix is termed appendectomy or appendicectomy.
It can be done in two ways:
Laparoscopic surgery is the commonly practised method unless the appendix has ruptured or if the appendix is located elsewhere.
The surgery done laparoscopically is relatively risk-free but complications that may arise after surgery include:
Bleeding at the surgery sites
Infection at the wound sites
Hernia at the incision sites
Both types of surgeries are done under general anaesthesia, and the risks associated with that would be present as well.
Antibiotics are also be given along with the surgery in order to treat the infection. It is however, not yet proven to be effective when given alone.
What is the prognosis of appendicitis?
If surgery is done before rupture of the appendix occurs, the prognosis is very good. Though appendix rupture was fatal in the past, with improvement in healthcare now, it also has a better outcome provided proper treatment options are available in a timely manner.
Chronic appendicitis occur in 1% of the cases. This means that the symptoms persist for 3 weeks or more and is relieved by the removal of the appendix. Some may get recurrent appendicitis, with pain that settles before treatment is sought, only to recur again at a different time.
- Independent Trajectory for India-Israel Ties
- Saudi Arabia’s heir apparent Crown Prince bin Salman and stake to greatness
- Interpreting Germany’s New Grand Coalition Deal: A First Assessment
- India’s IT Minister in SL
- PCoI bond scam report Over 60 MPs could be exposed – SLFP
- Off duty soldier tracks hit-and-run driver Police send letter of appreciation to Army HQ
- Mohammad Shiyam murder case appeal Vass denies threatening CID Director
- 5th Indo-SL Defence Dialogue concludes in Delhi
- Further evidence on Gammanpila- Shaddock case on 26th
- Impressed with Kite Festival Minister promises new fishing harbour for VVT
- Muslim women should enter politics – Dr. Uthumalebbe
- SEUSL VC urges undergrads to focus on education
- LG elections Vote-buying could lead to removal CaFFE warns candidates
- Motorcyclists Association complains to CJ Accuses Mathugama Chief Magistrate of bias
- Singapore PM & Indonesian President due next week
- Justice Surasena appointed President of CoA L.T.B. Dehideniya elevated to SC
- Fmr NFF Member Premalal Fonseka joins MS/SLFP Maheepala Herath supports ‘Pohottuwa’
- Namal’s money laundering case postponed to 6 Feb
- Kuruwita prisoner alleged torture case Complaint to be handed over to UN
- Asia’s largest haul of cocaine destroyed President Sirisena oversees process
- Missing women & PTA detainees Sasitharan urges families to register
- SLMC rally attacked in Palamunai Hakeem blames Bathiudeen’s ACMC
- Tissa gang-rape victim dies Suspects could be tried for murder
- President’s confidants named in PRECIFAC report JVP
- Supreme Court decides President’s term is five years Presidential Election Next Year President’s term ends in December 2019
- Selection of volleyball coaches Law violators to attend Interview?
- ‘Singer Cup’ Under-19 Schools Cricket Munasinghe scores century
- Tamim steers Bangladesh
- Louis denies creating a stir at meeting
- Jasprit Bumrah wickets follow Kohli century for India
- Houston Marathon in freezing weather Hiruni shatters SL record Qualifies for Commonwealth Games 2018
- “Nidahas Trophy 2018” SLC formally invites Bangladesh
- 12th ICC Under-19 Cricket World Cup Bangladesh record second win
- Sri Lanka Rugby Referees Association Jamaldeen unanimously re-elected President
- ‘Singer Cup’ Under-13 Division II Schools Cricket Mahanama, Henegama and Galahitiyawa advance
- Liverpool stun City
- Peterhansel rebounds as Sainz keeps Dakar lead
- Venus and Stephens crash out of Australian Open
- Suarez fires Barcelona nine clear
- I’m too old to be favourite - Federer
- Tri Nation series begins today Bangladesh, Sri Lanka, Zimbabwe seek to rebuild
- 12th ICC Under-19 Cricket World Cup Sri Lanka triumph by 7 wickets
- Premier League Tier A Milantha scores twin centuries Chilaw Marians register fourth win
- 700 wickets and 7000 runs Dilruwan reaches milestone in first class cricket
- Hathurusinghe savours new challenge
- Sri Lanka worst in Moody’s Asia Pacific ratings
- SL at 66th in WEF’s Manufacturing Index
- Kerawalapitiya-II gets greenlight
- Plans for multi-country trade hub in Sri lanka
- CEB picks swiss firm for vehicle charging network in Sri Lanka
- A tribute to a gentleman par excellence
- Brent crude oil rises to $70 on output cuts
- Airbus says A380 superjumbo production could end
- Asian shares gain as the dollar continues to struggle
- Slowdown in international trade and its impact on globalization
- Ford plans US$ 11 billion investment 40 electrified vehicles by 2022
- Sampath Bank engages with SMEs
- LB Finance crowned No 1 Finance and Leasing Brand in SL
- Hyundai Motor and Grab sign strategic partnership
- Mastercard holds Digital and Innovation Workshop in SL
- Zuckerberg aims to save Facebook from itself
- Is economic struggle driving North Korea to the negotiating table?
- Altair sponsors 146th AGM of Colombo Club
- From challenges to opportunities: The success of DSI Samson Group
- BMICH staff presents Carols
- The March of Folly Dr. Ranjith Atapattu, an exemplary figure
- Liberia’s development at risk
- Politicos’ image plummets to lowest ebb
- UN Agency says Losing US funds could be ‘catastrophic’ for Palestinians
- Central Bank Bond issue Opportunity to reveal true culprits lost
- ‘We don’t want to fool the Sinhalese and get our dues’
- Rohingya insurgents say 10 found in Myanmar grave ‘innocent civilians’
- Thalaivar’s New Avatar
- TNA: How better is ‘better’?
- Wi-Fi but no water: Can smart tech help a city's poor?
- No political solution for Tamil grievances in sight – Ananthy Sasitharan
- Division in SLFP main reason for UNP victory
- We don’t endorse Basil’s leadership
- Rogues in all Govts should be punished- Akila Viraj Kariyawasam
- EPRLF trying to create confusion – Thurairasasingham
- National Prosperity Turning the Tide
- Disposable coffee cups:British lawmakers call for “latte levy”
- If only we could crackdown on the root causes to effect sustainable solutions Herein lies a Nation’s progress
- Planetary combines that foreshadow misfortune for father
- Pirith chants for abundant harvest
- Venus into Capricorn
- Vastu and Domestic Animals
- Yoga for Children and Adults with Disabilities
- Notes on history: The thinkers and the doers
- Reflections on a nation of non-readers
- The Disaster Artist: The (un)making of a movie
- Our children and our cinema
- INTERPRETING ASIAN CINEMA: CHALLENGES AHEAD
- How Sanskrit journalism is slowly hogging headlines
- ice manufacturing in South Asia
- CMSC’s season finale concert
- Kite Surfing Lanka Kalpitiya An experience of a lifetime
- Ella and mini Adam’s Peak
- A cave of history -Ravana Cave
- Trump’s ‘madman’ ACT scared N. Korea to talks
- Calls for ‘revenge’ Israeli settler killed in attack
- Banning of Colombo Journal First English Newspaper
- Sri Lankan author publishes for the world
- Broadway brought to our own shores
- Celebrating the harvest