The appendix (appendectomy) is a closed-ended, narrow tube attached to the cecum (the first part of the colon) like a worm. Appendicitis is inflammation of the appendix and occurs when bacteria invade and infect the wall of the appendix. If the inflammation and infection spread through the wall of the appendix, the appendix can rupture.
After rupture, the infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (peri-appendiceal abscess) or even infection of the entire lining of the abdomen and the pelvis (diffuse peritonitis).
The most common manifestation of appendicitis is abdominal pain. Most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. Nausea and vomiting also occur in appendicitis and may be due to intestinal obstruction.
Appendicitis usually is first suspected on the basis of a patient's physical examination (pain, elevated temperature and usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there).
Diagnose can be confirmed with:
- a white blood cell count (becomes elevated with infection)
- urinalysis (microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine, also it is abnormal when there is inflammation or stones in the kidneys or bladder)
- an abdominal x-ray (may detect the fecalith – the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening)
- barium enema (x-ray test where liquid barium is inserted into the colon from the anus to fill the colon, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon)
- ultrasonography
- CT
Prior to an appendectomy and soon as appendicitis is suspected, antibiotics are almost always given to the patient.
During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall in the area of the appendix. The surgeon enters the abdomen, after examining the area around the appendix to be certain that no additional problem is present and then the appendix is removed by cutting it from the colon.
Laparoscopy is also one of the methods to diagnose appendicitis but is also a surgical procedure wherein a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall and allows a direct view of the appendix. If appendicitis is found, the inflamed appendix can be removed at the same time.
The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier recovery.
The patient is sent home from the hospital in 1 or 2 days. Patients whose appendix has perforated must stay in the hospital 4 to 7 days. Full recovery from appendectomies takes about 4 to 6 weeks but it can prolong to up to 8 weeks if the appendix had ruptured.
