Appendicitis

WHAT IS THE APPENDIX?

The appendix is a small closed-ended, narrow tube up to several centimetres in length that attaches to the cæcum. It is located in the lower right side of the abdomen, at the junction where the small intestine meets the large intestine. The appendix has no known function in the body.

WHAT IS APPENDICITIS?

Appendicitis means inflammation of the appendix. A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis during his or her lifetime.

WHAT ARE THE SYMPTOMS OF APPENDICITIS?

The distinguishing symptom of appendicitis is pain beginning around or above the navel. The pain, which may be severe or only achy and uncomfortable, eventually moves into the right lower corner of the abdomen. There, it becomes more steady and more severe, and often increases with movement, coughing, and so forth. The abdomen often becomes rigid and tender to the touch.

Loss of appetite is very common. Nausea and vomiting may occur in about half of the cases and occasionally there may be constipation or diarrhea. The body temperature may be normal or slightly elevated. The presence of a high fever may indicate that the appendix has ruptured.

The typical sequence of symptoms is present in about 50% of cases. In the other half of cases, less typical patterns may be seen, especially in pregnant women, older patients, and infants. In pregnant women, appendicitis is easily masked by the frequent occurrence of mild abdominal pain and nausea from other causes. Elderly patients may feel less pain and tenderness than most patients, thereby delaying diagnosis and treatment, and leading to rupture in 30% of cases. Infants and young children often have diarrhea, vomiting, and fever in addition to pain.

HOW IS APPENDICITIS DIAGNOSED?

To help diagnose appendicitis, your doctor will take a history of your signs and symptoms and examine your abdomen.

Tests and procedures used to diagnose appendicitis include:

Physical exam to assess your pain: Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).

Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.

Blood test: This allows your doctor to check for a high white blood cell count and CRP which may indicate an infection.

Urine test: Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.

Imaging tests: Your doctor may also recommend an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.

WHAT ARE THE COMPLICATIONS OF APPENDICITIS?

Appendicitis can cause serious complications, such as:

A ruptured appendix: A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.

A pocket of pus that forms in the abdomen: If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two

weeks, and you're given antibiotics to clear the infection. Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

WHAT IS THE TREATMENT FOR APPENDICITIS?

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 5 to 10 centimeters long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Expect to spend two or three days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess.

Appendectomy can be performed several weeks later after controlling the infection.

Nonsurgical treatment

If you have only some of the symptoms of appendicitis and your surgeon considers that you don’t need immediate surgery you may be treated by antibiotics and watched for improvement. In an uncomplicated appendicitis antibiotic therapy may be effective but there is a possibility of reoccurrence.

WHAT ARE THE COMPLICATIONS OF APPENDECTOMY?

Infection occurs in 2-4% of cases, it can be an infection of the surgical incision or an abscess (a collection of pus in the area of the appendix).

Other complications may occur such as blood clot, heart problems, breathing difficulties; they are higher in smokers, obese patients, and those with other diseases such as diabetes, heart failure, renal failure and lung disease. Wound healing may also be decreased in smokers.

WHAT CAN I EXPECT AFTER MY SURGERY?

After surgery, your doctor may prescribe antibiotics and pain medication.

You may stay at the hospital up to 1 or 3 days after laparoscopic surgery, longer after open surgery or if your appendix is ruptured.

During the first week after surgery slowly increase your activity but do not lift heavy weights and participate in strenuous activity. Children can usually go to school 1 week after an operation for a non-ruptured appendix and up to 2 weeks after a ruptured appendix. Most children can resume all sport activities 2 weeks after the surgery.

Your scar will completely heal in about 4 to 6 weeks and will become softer and continue to fade over the next year.

This information is for education purposes and is not intended to replace a consultation with specialist doctor. If you have questions concerning your care, please discuss with your doctor.

For further information about appendicitis, please contact us at: (84-24) 3577 1100 or send us an inquiry here