Appendicitis

Symptoms
  • Abdominal pain
  • Nausea
  • Vomiting
  • Fever
  • Loss of appetite
  • Constipation
  • Diarrhea
  • Abdominal swelling
  • Fatigue

Description

Appendicitis is the painful swelling of the appendix, the finger-like organ attached to the large intestine in the lower right side of the abdomen. The pain is initially felt around the umbilicus (belly button) area, which later spreads to the lower right side of the abdomen becoming more intense and persistent. If untreated, an infected appendix can burst and result in potentially life threatening infection spreading throughout the abdominal cavity (a condition called peritonitis) and into the bloodstream. Appendicitis is a common cause for emergency abdominal surgery affecting all age groups, particularly of high incidence in adolescents and children within the age group of 10 to 20 years.

Causes

A partial or complete obstruction of the appendiceal lumen (inside of the appendix) results in appendicitis. The blocked appendix becomes an ideal site for bacterial growth resulting in infection and swelling. While stool and mucus accumulation is found to be the primary source of blockage, parasitic worms or tumors can also contribute to the blockage. Obstruction of the appendix is also caused by enlarged lymph tissue (following infection in the gut and other parts of the body), inflammatory bowel diseases (like Crohn’s disease and ulcerative colitis), irritation, ulcers of the gut, and abdominal trauma.

Treatment

Surgical therapy

Surgical removal of appendix (appendectomy) is the preferred treatment approach to appendicitis. To avoid postoperative wound infection and abscess formation, patients undergoing surgery are treated with intravenous antibiotics along with fluid and electrolyte replacement. In uncomplicated appendicitis, most patients resume oral intake within hours of the operation and are hospitalized for a day or so, or may be discharged the same day. Complicated cases with an abdominal perforation (opening) may require longer hospital stays.

Two commonly performed surgical methods are open appendectomy or laparoscopic (keyhole) appendectomy, both of which are carried out under general anesthesia.

In open appendectomy, the infected appendix is removed through a single incision in the lower right area of the abdomen. This procedure is required in case of a ruptured appendix or peritonitis, and it also allows the surgeon to clean the abdominal cavity.

In the case of abscess formation around the ruptured appendix, the pus may be removed through a drainage tube that is placed through the abdominal wall. The pus is drained during surgery or more commonly before the surgery over a period of two weeks along with antibiotic treatment. After six to eight weeks when the infection and inflammation are reduced, the remains of the burst appendix is then surgically removed.

In laparoscopic appendectomy, the surgeon makes several smaller incisions in the abdomen and inserts special surgical tools through the incisions to remove the appendix. Generally, laparoscopy has a shorter recovery time and the least scarring.

Non-surgical therapy

Nonsurgical treatment involves treatment with broad spectrum antibiotics to treat the infection and avoid further complication. Treatment with antibiotics is considered for uncomplicated appendicitis, unclear diagnosis, or when the individual is considered not fit for surgery.

Along with medication, a healthy diet consisting of easily digestible food low in fiber content is suggested to the patient until the severity of the infection is reduced.

References

Page last updated: August 14, 2014
  • Humes, D. J., & Simpson, J. (2006, September 9). Acute appendicitis. British Medical Journal, 333(7567). Retrieved December 3, 2013, from American College of Surgeons: http://www.facs.org/public_info/operation/brochures/app.pdf.
  • National Institute of Diabetes and Digestive and Kidney Diseases. (2013, September). Appendicitis. Retrieved December 4, 2013, from National Institute of Diabetes and Digestive and Kidney Diseases: http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/appendicitis_508.pdf.
  • Torpy, J. M., Burke, A. E., & Golub, R. M. (2011, 12 07). Appendectomy. Journal of the American Medical Association, 306(21).
  • Varadhan, K. K., Neal, K. R., & Lobo, D. N. (2012). Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. British Medical Journal, 344.
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