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.
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