Appendicitis is the term which is actually an inflammation of the vermiform appendix which, in humans, has no known function. It is rich in lymphoid tissue which gradually shrinks with advancing age. In majority cases, appendicitis is an acute condition.
The appendix is a small, worm-like, tubular appendage attached to the cecum of the colon. The appendix is a thin pouch attached to the large intestine on the right side of the abdomen. It is usually about the size of a finger.
Appendicitis is a medical emergency that almost always requires prompt surgery to remove the appendix. An inflamed appendix will eventually burst when left untreated spilling infectious materials into the abdominal cavity.
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Symptoms of Appendicitis:
- pain around the belly button
- lower right side abdominal pain
- loss of appetite
- inability to pass gas
- abdominal swelling
- low-grade fever
- a sense that you might feel better after passing stool
Appendicitis pain may start off as mild cramping. It often becomes more steady and severe over time. Appendicitis can sometimes affect urination.
Diagnosis of Appendicitis:
Diagnosing appendicitis is tricky. Symptoms of the appendicitis are vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, intestinal infection, and ovary problems.
The following medical tests are usually used to diagnose appendicitis:
- Abdominal exam to detect inflammation
- Urine test to rule out a urinary tract infection
- Rectal exam
- A blood test to see if your body is fighting infection
- CT scans and/or ultrasound
The appendix is removed with the laparoscopic instruments placed into the small incisions made in the abdomen by the surgeon.
This laparoscopic technique is very common for simple appendicitis surgery. The surgeon will make 1 to 3 small incisions of keyhole size in the abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process will help the surgeon to see the appendix more easily. A laparoscope is inserted through another port, it actually looks like a telescope with a light and a camera on the end so the surgeon can see inside part of the abdomen. Surgical instruments are placed in the other small incisions and will be used to remove the appendix. The carbon dioxide comes out through the slits, and then the incisions are closed with sutures or stapled or covered with glue-like bandage and steri-strips.
Generally, the surgeon may start with a laparoscopic technique and may need to shift to an open surgery technique also depends on the patient’s condition and will be done for the patient’s safety.
The appendix will be removed through an incision in the lower right abdomen.
The surgeon makes an incision of about 2 to 4 inches long in the lower right side of the abdomen. The appendix will be removed from the intestine and the surgical area will be washed with sterile fluid to decrease the risk of further infection. A small drainage tube may be placed going from the inside to the outside of the abdomen. This drain pipe placed in the abdomen will be removed in a day during the stay in the hospital. The wound will be closed with glue-like bandage or Steri-Strips.
Surgery is the standard treatment for an acute (sudden) infection of the appendix. Antibiotic treatment might be used as an alternative for a specific set of patients and also in children in some cases.
Preparation for Surgery:
- Health Ailments
- Stay in Hospital
The patient should inform the medical history to the surgeon. Any health ailments like suffering from diabetes, hypertension, kidney diseases, lung diseases, etc. should be informed to the doctor.
The patient should also inform the current medication, hence the doctor will know if any blood thinners are being used. These may need to stop at least 2 days before the surgery to avoid heavy blood loss or further complications during the procedure.
The patient will have a counseling session with the Anesthetist before the procedure to get clearance for the anesthesia during the procedure.
The patient needs to inform all the medication and lifestyle habits like smoking, alcohol intake and the frequency. Hence the anesthetist may prescribe to quit smoking etc. before the procedure.
This helps to avoid complications when the patient is under anesthesia.
The patient may need to avoid taking food and liquids during the investigations and the procedure. Hence it may avoid complications when the patient is under anesthesia.
Stay in Hospital:
Be prepared for the hospital stay. Generally, for a laparoscopic procedure, the duration of stay in the hospital may take 1 or 2 days and for open surgery, the duration of stay may take around 1 to 3 days. The stay in the hospital may also increase if the patient has a ruptured appendix.
Post Surgery Care and Diet:
Post-surgery the patient may need to stay in the hospital under observation for about 1 day and later can discharge and move back home. However, the doctor prescribes a few medications over a period of time to reduce post-surgery complications and risks. Also, the patient will be prescribed with a diet plan and the set of physical exercises which helps for a speedy recovery.
Here are a few common tips for post-surgery care:
|S. No||Post Surgery||Tips|
|1||Nutrition||Patients may be given with less amount of liquids immediately after the surgery (on the same day) and later after some time with regular food. The patient should drink lots of fluids, about 8 to 10 glasses per day. High-fiber food should be preferred in diet, hence patient need not strain during bowel movements. Foods high in fiber include beans, cereals, and whole-grain bread, peas, dried fruits, sweet corn, apples, and nuts|
|2||Physical Activities||Walking every hour will prevent blood clots. Do not lift heavy weights for at least 7 days after laparoscopic surgery and at least 3 weeks after open surgery. The patient may commonly feel tired post-surgery, getting adequate rest helps to recover faster.|
|3||Bowel Movements||The patient may have loose watery stools for a few days after intestinal surgery. Pain killer medicine may cause constipation. The best way to overcome the constipation is to increase the fiber in the diet, prefer fiber-rich foods.|
|4||Wound Care||This is common for all surgical procedures to always wash your hands before and after touching the wound. Do not soak the wound in water until the stitches are removed. A small amount of discharge from the wound incision is normal. If it is thick and yellow or redness at the wound, it is an infection. Consult the doctor immediately. Avoid tight clothing, this may rub against the incision and slows down the healing process.|
Risks of Appendectomy:
Like other operations, even appendectomy has set off a few risks and complications involved and the surgeon who performs the procedure will ensure to minimize the risks.
Here are a few common risks involved in Appendectomy procedure:
|S. No||Risk / Complication||Percentage||Useful Info|
|1||Intestinal Obstruction(Short-term blockage of stool or fluids)||3%||The swelling of the tissue around the intestine can stop stool and fluid from passing. If there is any temporary blockage of passing fluids then a tube may be inserted through the nose into the stomach, maybe for 1 or 2 days to remove the fluids from the stomach.|
|2||Pregnancy Risks||Premature labor 8 to 10%Fetal loss 2%||The risk of the fetal loss may increase to 10% when the appendix ruptures and there is peritonitis which is an infection caused at the abdominal cavity.|
|3||Pediatric risks||Less than 1% for all the complications||Children with a perforated appendix have increased wound infection rates and abdominal infections.|
|4||Wound Infection||Open Surgery 4.3%Laparoscopic 1.9%||Infection in the area of the incision or near the organ where the surgery was performed. Generally, antibiotic medicines will be given before and after the procedure. Smoking may also increase the risk of infection.|
|5||Pneumonia||Less than 1%||Pneumonia is an infection in the lungs. Avoid heavy walking, deep breathing and smoking post-surgery which helps to prevent any lung infections.|
|6||Urinary tract infections||Less than 1%||UTI is an infection of the urinary bladder or the kidneys. If a draining tube is placed post-surgery, this may cause urinary tract infection which includes pain during urination and fever.|
|7||Blood clot||Less than 1%||A blood clot in the legs can travel to the lungs. Longer bed rest may lead to this complication, regular walking may reduce the risk.|
|8||Heart complication||Less than 1%||May lead to a heart attack. General anesthesia applied during the surgery may worsen the problems with the heart and lungs. The anesthetist will suggest the best possible option based on a patient’s health condition.|
|9||Other complications||Open surgery 6.4%Laparoscopic 3.4%||Surgical infections, blood clots, breathing difficulties, kidney problems, and heart problems are other complications involved. These complications are higher in people who smoke, who are obese and those with other health ailments like diabetes, chronic kidney diseases, and lung diseases.|
Frequently Asked Questions:
Anesthesia used during the procedure will cause few side effects. Generally, anesthesia may affect the functioning of the heart and lungs. The patient needs to update the medical history to the anesthetist during the pre-surgery counseling, hence the anesthetist will choose the best possible way for applying the anesthesia.
The laparoscopic technique is the latest method used to remove the appendix. This procedure is performed with minimally invasive technique, where during the procedure 2-3 small incisions will be made each of a keyhole size. This is the most used method nowadays, where a patient can have a speedy recovery, less blood loss, less pain and less duration of stay in the hospital.
However, for a few patients, the laparoscopic technique may not be applicable and hence doctor may decide to go for an open surgery during the procedure. In such cases, the other parameters involved in speedy recovery may increase.
Compared to open surgery technique, a laparoscopic technique will have less pain. General surgical pain will be there for about 7 days until the incision gets completely healed. However, the patient will be prescribed with painkillers which helps to reduce the pain after the surgery.
- Appendectomy by American College of Surgeons from https://www.facs.org/~/media/files/education/patient%20ed/app.ashx
- Laparoscopic versus conventional appendectomy by Zhang J from www.ncbi.nlm.nih.gov/pmc/articles/PMC2988072
- Endoscopic Appendectomy by K. Semm from https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2007-1021466
- Acute appendicitis: US evaluation using graded compression by JB Puylaert from https://pubs.rsna.org/doi/abs/10.1148/radiology.158.2.2934762