What is appendicitis?
Appendicitis is an acute or sometimes chronic, progressing disease of the abdominal cavity caused by infection or blockage of the appendix – the appendix of the caecum. Appendicitis may develop at any age, but most often it occurs in adolescents and young people. Most of surgeries on the abdominal organs are just about appendicitis.
The appendix is a vestigial organ, its function is unknown, it has a form of a long, narrow, wormlike tube closed at the end and connected to the cecum – the lower part of the bottom section of the large intestine. Its diameter is about 1.2 cm and the length ranges from 3.8 to 20 cm. Appendix may be differently situated, so appendicitis is easy to confuse with almost any disease of the abdominal cavity.
It happens that that the human body has such a strong immunity that it is capable to suppress the appendix inflammation on its own. However, with the immunity weakening or increasing of abdominal muscles load the inflammation “raises its head” again. This so-called chronic appendicitis – a man is suffered from pain in the right iliac region from time to time. Chronic appendicitis causes continuous discomfort: each attack of appendicitis may provoke peritonitis development and it makes a person contact a doctor on a regular basis. Chronic appendicitis does not require removal of the appendix, however, if attacks are frequent it is better to remove the appendage.
Diagnosis of appendicitis
It can be difficult to diagnose appendicitis as appendicitis symptoms vary depending on the location of the appendix, and the doctor can’t “see” through the patient’s abdomen. Traditionally appendicitis diagnosis is based on blood and urine tests. The number of white blood cells in the blood increases and protein appears in urine. However diagnostics of appendicitis is not limited by these tests.
X-ray examination is a rare procedure as it is used more frequently while appendicitis diagnostics in children. X-rays can only detect fecalith blocking the appendix. In order to diagnose acute appendicitis ultrasonography is used. If the cause of pain is not the appendix, then it is almost not seen by ultrasound and if it is inflamed, the appendage will be seen as a tube with a diameter of about 7 mm and the doctor will see fluid around. Another diagnostic procedure is a computer tomography. CT gives an image of enlarged appendix in the same manner and affected tissues of bowel and peritoneum are also seen. Laparoscopy allows a direct view of the appendix. A small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. It is the most reliable method of diagnostics.
If a patient suffered from pain is admitted to hospital no doctor will operate on him immediately. This is due to the fact that many other disorders such as inflammatory processes in kidneys or inflammation of the genital organs in women may mimic appendicitis symptoms. Therefore, physicians will first observe the development of the disease for some time, gather tests and then make conclusion on possible surgical intervention. If the acute appendicitis is diagnosed, the treatment will be operative. Appendectomy may be performed in two ways: traditional and endoscopic.
Traditional surgery implies an incision 8-10 cm in length made over inflamed appendix. A surgeon cuts the muscles, examines the appendage and if the surrounding tissue is not inflamed, the appendix is removed and the hole in the bowel at the site of appendix attachment is closed with stitches.
A thin tube with a camera is inserted into the abdomen while endoscopic surgery. The doctor sees the image on the monitor. Tools are inserted through special incisions and the appendix is removed under continuous visual control. Endoscopic incisions are very small, so post-operative period is much easier and faster. Modern surgery is so good that patients with uncomplicated appendicitis leave the hospital next day after surgery. If appendix has finally ruptured and peritonitis has begun, the patient should stay at the hospital for about a week. During this period the patient receives intravenous antibiotics, which help the body to fight infection development. As soon as the patient is admitted to hospital with suspected appendicitis, the doctor immediately orders antibiotics (cefazolin, cefantral, erythromycin and others) as it is necessary for infection prevention in post-operative period. No special diet is required after the removal of the appendix.