Appendix is a small worm like structure attached to the cecum, the beginning of the colon, on the lower right side of abdomen. During first few years of life, appendix functions as part of the immune system, but after that it does not have any known function. Sudden inflammation of appendix is known as Appendicitis- and if you are able to recognize its symptoms, you can prevent serious appendicitis complications from occurring. The most serious complication of appendicitis is an infection of the lining of your abdominal cavity (peritonitis). This may occur if your appendix ruptures (perforates) and the contents of your intestines and infectious organisms invade the peritoneal cavity. Peritonitis is a medical emergency.
What is Appendix?
The appendix is a narrow, small, finger-shaped portion of the large intestine that is generally situated near junction of small and large intestine (Cecum) on lower right side of the abdomen.
What Causes Appendicitis?
Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, but if left untreated, it can burst,or cause infection. It primarily occurs when the interior of the appendix becomes filled with something like mucus, bacteria, foreign materials, parasites or hard stools. This causes swelling in the appendix, thereafter leading to irritation and inflammation. Appendix may perforate, allowing stool, mucus, and other substances to leak through and get inside the abdomen causing localized abscess or generalised infection of abdomen (peritonitis).
What are the symptoms?
- Abdominal pain - pain may begin around the belly button and then get localized in right lower abdomen
- Abdominal pain may be worse when walking or coughing
- Loss of appetite
- Fever usually occurs within several hours
- Rectal tenderness
- Chills and rigours
Diagnosis of Appendicitis
The diagnosis of appendicitis begins with a thorough history and physical examination. As patients usually have an elevated temperature, there is moderate to severe tenderness in the right lower abdomen, when the doctor physically examines it. In case, inflammation has spread to the peritoneum, there can be a frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness.
The following tests are usually used to make the diagnosis:
- Blood test to look for signs of infection
- Urine test to rule out other conditions, such as a bladder infection
- Computerised tomography (CT) scan or an ultrasound scan to see if the appendix is swollen
What are the treatment options available for appendicitis?
- Laparoscopic method - The appendix is removed with instruments placed into small abdominal incisions.
- After administering anesthesia the abdomen is prepared with an antibacterial solution.
- The peritoneal cavity is inflated with gas (usually carbon dioxide).
- The surgery begins with a small abdominal incision below to the belly button in the skin crease, which allows the insertion of the laparoscope. Another two or three small incisions may be necessary to insert the laparoscopic instruments to dissect and remove the appendix.
- Using the laparoscopic surgical tools, the tissues and vessels surrounding the appendix are cut and tied.
- The appendix is put in a plastic bag before being removed through the small incision to prevent infection of wound.
- The abdominal cuts are all closed with clips, which are likely to leave insignificant scars.
- The removed appendix is sent to a pathology lab for biopsy.
What are the advantages of laparoscopic appendectomy?
The main advantages are:
- Less post-operative pain
- Faster recovery
- Short hospital stay
- Less post-operative complications like wound infection and adhesion