Appendicitis
The appendix is a finger-shaped tube, 8-9 cm long extending from the right side of the large intestine. The exact function of the appendix is not clear. Appendicitis is a condition in which the appendix becomes inflamed and filled with pus. It is a medical emergency requiring immediate surgical removal of the appendix. If it is left untreated, there are chances the appendix will burst spreading infectious material into the abdominal cavity (peritoneum). This can inflame the abdominal cavity, a condition called peritonitis, and sometimes be fatal if not treated urgently. Appendicitis can strike at any age, but it is common between the ages of 10 and 30 years.
Causes
The causes of appendicitis can include:
- Obstruction of the appendix cavity by a faecal stone (hard piece of stool), food wastes or tumour
- Gastrointestinal infection
- Inflammation
These can cause the bacteria naturally present in the appendix to rapidly multiply, leading to inflammation and infection.
Signs and Symptoms
The signs and symptoms of appendicitis include:
- Mild pain in the upper abdomen and belly button region that increases to sharp pain as it moves into the lower right abdomen
- Rebound tenderness: pain increases when pressure is applied to the painful area and then released
- Pain with coughing or walking
- Abdominal swelling and cramps
- Loss of appetite
- Nausea and vomiting
- Bloating
- Low-grade fever
- Painful urination
- Constipation or diarrhoea
Diagnosis
It can be difficult to diagnose appendicitis as the symptoms are similar to other health problems.
Your doctor will evaluate your symptoms and conduct a physical examination of your abdomen.
Diagnostic tests
- Blood test to check for high white blood cell count
- Urine test to exclude urinary tract infection or 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.
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 appendectomy: Your surgeon will make small incisions in the abdomen and insert a laparoscope. The laparoscope has a lighted camera, which will help your surgeon view the operation site on a large monitor. Carbon Dioxide 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 and with fewer scars. However, if the appendix has ruptured and the infection has spread, you may have to undergo an open appendectomy, which will allow your surgeon to thoroughly cleanse the abdominal cavity of any infectious material.
Open appendectomy: Your surgeon will perform open surgery through an incision of 5 to 10 cm on the abdomen and remove the appendix. If the appendix has ruptured, the peritoneal cavity will be thoroughly irrigated to remove any pus.
