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Appendicitis

What is appendicitis?

The appendix is located on the right lower quadrant of abdomen and is attached to initial portion of the large intestine and is a worm-like extension. Also known as the vermiform appendix, it is approximately 8 to 10 cms in length. In cases of appendicitis, the inner lining of the appendix is inflamed and this spreads to the other parts. Treatment of appendicitis is a clinical emergency because; if ignored, the appendix can burst or perforate spilling infectious, fluid-filled bacteria into the abdominal cavity. In such a case, surgery is imperative and may be performed in an emergency basis. Sometimes, appendicitis can be managed without surgery, if it is mild and pain subsides in 24 hour time after the onset.

Causes

The causes of appendicitis are attributed to:

  • Blockage of the appendiceal lumen

  • Lymphoid hyperplasia secondary to IBD

  • Infections

  • Faecal stasis and feacaliths

  • Parasites

  • Foreign bodies

All or any of the above blocks the appendix causing inflammation.

Signs and symptoms

  • Abdominal pain that occurs suddenly around the umbilicus and then spreads to the right lower quadrant of the abdomen

  • Nausea and vomiting (after abdominal pain)

  • Loss of appetite anoerexia

  • Worsening fever with progress of illness

  • Abdominal bloating

Tests

  • Physical examination: Patients suffering from appendicitis display classic signs most of the time during a physical examination.

  • Lab and blood tests:

    • CBC a complete blood count in a patient with appendicitis will show elevated counts of WBC > 10,500 cells/uL

    • Neutrophilia is > 75%

    • CRP C-reactive protein levels are usually > 1 mg/dL in patients diagnosed with appendicitis

    • Urinalysis rules out other urinary tract infections

  • Imaging Studies:

    • CT scanning with or without oral contrast is usually diagnostic of appendicitis.

    • Ultrasonography can provide a clear view if the appendix is significantly inflamed.

Treatment

The only treatment modality for severe appendicitis is an appendectomy or surgical removal of the appendix. Laparoscopic appendectomy uses three cannulae. Two of them one umbilical and suprapubic have a fixed position. The third one is placed in the right periumbilical region. The appendix is identified and retracted. The blood vessel to appendix is divided and transected after tying the base of the appendix.

Dr. Deepak Varma is a renowned surgical gastroenterologist having performed several successful laparoscopic appendectomies.