Introduction
- Appendix is a blindly ending tube like structure attached to the large intestine. It is commonly positioned at the lower right side of the belly.
- The appendix has no particular function in the body and is a vestigial organ.
- Being blind ended, it is prone to infection by gut organisms
- Infection of the appendix is called appendicitis.
- Acute appendicitis is a surgical emergency and is best treated within 48 hours of onset of symptoms
- Timely removal of appendix by laparoscopy results in a complete quick recovery.
Signs and symptoms
- Pain in the belly, starting at the belly button and then extending to the right lower side is typical of appendicitis
- Pain gets worse on walking, coughing and straining.
- Patient is most comfortable lying still
- Pain may be accompanied by
- nausea and vomiting
- Fever
- Constipation
- A ruptured appendix makes the patient very sick and can cause generalised sepsis and death
- Sometimes a delay in seeking medical attention can cause localised mass formation around the appendix. In this situation it is safer to treat the patient with medication first and remove the appendix after an interval of 6 weeks.
Diagnosis
- Appendicitis can be diagnosed by classical signs and symptoms as described above
- These are corroborated by additional blood tests to look for infection
- An abdominal ultrasound or a CT scan can confirm or refute the presence of infection in the appendix in case of ambiguity
Treatment
- Removal of appendix (appendectomy) can be done by an open cut or laparoscopy. The procedure is the same only the approach changes
- Laparoscopic appendectomy is done by three punctures on the abdominal wall (Fig)
- Laparoscopy has all advantages of minimal access approach viz minimal pain, short hospital
- stay, early recovery, less chance of wound infection
Post operative recovery
- Patient is able to walk a few hours after surgery
- Depending on the severity of infection, oral diet is initiated starting with fluids and progressing to soft and finally normal diet over the course of a few days.
Patient is discharged a day or two following surgery.