Which structure is called appendix?
Appendix is a narrow, hollow and muscular tube like structure present near the junction of the small and the large intestine (called the Ileocaecal junction). In human beings it has no significant functions.
What is the meaning of Appendicitis?
When the appendix gets infected or inflammed it is called appendicitis. When the process occurs suddenly it is called acute and when keeps recurring it is called recurrent appendicitis.
What is the cause of appendicitis?
In majority of the cases of acute appendicitis (80%) it is due to the obstruction of the lumen of the appendix. It occurs when hard food material (fecolith) gets stuck, intestinal worms get stuck up etc. In very rare cases foreign body like seeds may also get stuck up causing the inflammation and appendicitis.
Who usually suffer from appendicitis?
It is the disease usually occurring in young adolescence age group (second decade of life). But it may occur in any age group.
How is the presentation?
Initially the patient develops pain around the umbilicus which in few hours gradually shifts towards the right lower side of the abdomen. Any strain, coughing or bending increases the pain. The pain is more after food. Pain is associated with feeling of nausea and vomiting. There may be associated burning on passage of urine and diarrhoea. In late cases the patient also develops fever and abdominal distension which are not good signs and indicate the complications.
How can one diagnose appendicitis?
Above symptoms are very much indicative, plus on examination there is tenderness over right lower side of abdomen on touch. The blood investigations indicate increase in white blood cell count (WBC Count). Acute appendicitis is one of the most common emergency and requires urgent surgery.
Special Investigations Required for Confirmation?
Basically it is diagnosed clinically by the doctor on taking history and examination. But for confirmation most basic investigation like abdominal ultrasound will suffice. In very rare cases an Abdominal CT Scan may be required.
Any different mode of Presentation other than the above?
Sometimes patients develop what we call sub-acute appendicitis. In this the patient may present with nonspecific symptoms like fullness of abdomen after meals, mild pain in right side o
f abdomen and around umbilicus. The symptoms may subside after few days of simple antibiotics and analgesics only to keep appearing off and on. This are the sub-acute cases in which the investigations may prove to be normal. This cases are usually diagnosed by the clinician from the detailed history of the patient and from proper clinical examination.
Complications of Appendicitis?
Most feared complication is perforation or rupture of appendix. This results due to severe inflammation of appendix without treatment. It causes generalized abdominal infection, pus collection (intra-abdominal abscess) and septicaemia (toxic level of infection in blood). This is a life threatening consequence requiring urgent intervention and surgery.
Treatment Option of Appendicitis?
The treatment is Surgery (Appendicectomy). It can be done by open method or laparoscopically. Open method is now rarely performed except for few instances.
Laparoscopic Appendicectomy is performed by making three tiny holes (of size 3 – 10 mm) in abdomen through which camera and instruments are introduced, surgery is performed and appendix is removed. The advantage of appendix is less pain, early recovery and excellent cosmetic outcome. In addition rest of the abdominal cavity can also be examined for any other pathology.
Can one live without Appendix? Any side effects of removal?
Appendix is one of those organs which has no definitive function in human beings and hence is called a vestigial organ. Hence after removal it doesn’t cause any consequence.
Open or Laparoscopic Approach?
Laparoscopy is obviously the better option due to less post-surgical pain, early recovery and good cosmetic outcome. There is also an advantage of ruling out any other associated or non-associated pathology in the same surgical sitting. Hence is the gold standard treatment option for appendicitis.