Appendicitis
The appendix is a finger-shaped tube 3½-inches long extending from the right side of the large intestine. The exact function of this organ is not very clear. Appendicitis is a condition in which the appendix becomes inflamed and filled with pus. If it is left untreated, there is a chances the appendix will burst, spreading the infectious material into the abdominal cavity (peritoneum). This can inflame the abdominal cavity, a condition called peritonitis, and can sometimes be fatal if not treated urgently. Appendicitis can strike at any age, but is common between the ages of 10 and 30 years.
Causes
The causes of appendicitis can include:
- Obstruction of the appendix cavity faecal stone (hard piece of stool), food wastes, or tumour.
- Gastrointestinal infections
- Inflammations
These can cause the bacteria naturally present in the appendix to rapidly multiply leading to inflammation and infection.
Signs & Symptoms
The signs and symptoms of appendicitis include:
- Mild pain in upper abdomen and belly button region that increases to sharp pain as it moves into the lower right abdomen
- Rebound tenderness: when pressure is applied to the painful area and then released, the pain increases.
- Pain with coughing or walking
- Abdominal swelling and cramps
- Loss of appetite
- Nausea and vomiting
- Bloating
- Low-grade fever
- Painful urination
- Constipation or diarrhea
Diagnosis
It is difficult to diagnose appendicitis as the symptoms are similar to other health problems.
Your doctor will examine your symptoms and conduct a physical examination of your abdomen.
Diagnostic tests include:
- Blood test to check for high white blood cell count
- Urine test to exclude urinary tract infection or a kidney stone
- Imaging tests including abdominal X-ray, ultrasound or computerized tomography (CT) scan
Treatment
Surgery is the standard treatment for appendicitis. Antibiotics are often given before surgery. A proportion of people with appendicitis may improve with intravenous antibiotics alone, this requires close observation in hospital for several days. Predicting who can be treated with antibiotics alone is difficult and often requires a CT scan and blood tests.
If it has been a few days since your appendix burst, your doctor might decide not to do surgery at all. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In a case like this, doctors usually give antibiotics and carefully watch the person. They might be able to avoid doing surgery right away, since it can be more difficult in people who fit this description. But many people will need surgery later to take out the appendix.
Your doctor will perform the surgery under general anaesthesia. The surgical technique for removal of the inflamed appendix will depend on you and your surgeons’ preference and whether the appendix has ruptured.
The surgical techniques include:
Laparoscopic appendicectomy: Your surgeon will make small incisions in the abdomen and insert a laparoscope and other tiny instruments through them. The laparoscope has a lighted camera, which will help your surgeon view the operation site on a large monitor. A gas will be pumped in to separate the abdominal walls from the other organs and allow better visibility. Your surgeon will then remove the appendix.
Laparoscopic surgery will allow you to recover faster with fewer scars. However, if the appendix has ruptured and infection has spread, you may have to undergo open appendectomy which will allow your surgeon to thoroughly cleanse the abdominal cavity of any infectious material.
Open appendicectomy: Your surgeon will perform an open surgery through an incision of 2 to 4 inches on the abdomen and remove the appendix. If a rupture has occurred, the peritoneal cavity will be thoroughly irrigated to remove any pus.