Acute appendicitis is a clinical condition where the appendix gets inflamed. It can cause severe abdominal pain and often require surgery. It is a medical emergency.
Let’s briefly have a look at what this condition is.
What Is The Appendix?
The appendix is a tiny little structure that is present on the side of the large bowl. It is what is called a vestigial organ, as it has no role in humans. Its position next to the bowel can vary as well.
Inflammation of the appendix is called appendicitis.
How Common Is Acute Appendicitis?
Appendicitis is often seen in individuals between the ages of 10 and 20 years. However, I have seen numerous cases in older adults. It tends to be more common in men.
What Causes Appendicitis?
Any condition that blocks the appendix can lead to appendicitis. For example, within the appendix is tissue called lymphoid tissue. When this overgrows from either infection or inflammation, it can lead to appendicitis.
Stool that is present in the bowel can become infected within the appendix. Calcium deposits on this, leading to a condition called fecolith.
Numerous bacteria have been implicated in the development of the condition as well. Common organisms include Escherichia coli, Peptostreptococcus, Bacteroides, and Pseudomonas.
What Are The Symptoms Of Appendicitis?
The most common symptom that patients present is acute abdominal pain that starts suddenly without any warning. The pain starts in the middle of the abdomen and then slowly progresses to the right low respect of the abdomen. It is a squeezing sort of pain that is often followed by vomiting.
Very often patients double up in pain and draw their knees up towards their abdomen to avoid the pain from getting worse.
Other than that, patients may have a low-grade fever. Nausea and loss of appetite are common symptoms. Nearly 20% of patients may develop diarrhea or constipation.
When the doctor examines the patient, there can be marked tenderness in the umbilical area and right lower abdomen. Patients may have dry mouths and bad oral odor.
As such, there are no specific blood tests that can help determine whether a patient has appendicitis.
Nonetheless, you may be asked to undergo a complete blood count, liver function test, pancreatic function test, urine examination, C-reactive protein, and even a pregnancy test if you are a woman (this is because ectopic pregnancy can sometimes appear like appendicitis).
When both the WBC and CRP results are normal, acute appendicitis can be ruled out with 98% accuracy. A WBC count of 17,000 cells/mm3 or more is linked to problems with acute appendicitis, such as perforated and gangrenous appendicitis.
A specialized blood test called urinary hydroxy indole acetic acid (5-HIAA) can be useful as its levels are elevated in acute appendicitis and are reduced when the appendix becomes damaged irreparably.
Radiological investigations, such as an ultrasound scan of the abdomen and a CT scan can be helpful.
Ultrasound is a very safe test and has no side effects. It is quick to perform and often helps make a diagnosis early. A normal appendix is rarely seen on ultrasound, while an inflamed appendix can be clearly seen.
In patients in whom the ultrasound is inconclusive, the American College of Emergency Physicians recommends a CT scan of the abdomen. More than 95% of the time, a CT scan of the abdomen can tell if someone has appendicitis.
Yeah, if your doctor suspects that you have appendicitis, you will be asked to undergo tests to confirm the diagnosis.
Treatment Of Appendicitis.
The best treatment for appendicitis is the surgical removal of the appendix. This is called appendicectomy or appendectomy.
Medicines alone cannot help this condition. Surgery is considered the gold standard of management.
Recent data has suggested that non-operative management can be safe for uncomplicated cases of appendicitis. This means patients will be given some conservative medical management with a plan of performing surgery a little bit later. Eventually, surgery will need to be performed.
The laparoscopic method is better than the open method for removing the appendix. Most appendicectomies that aren’t hard to do are done with a laparoscope.
Several studies have compared the results of patients who had an open appendicectomy to those who had laparoscopic surgery. The results showed that the second group was less likely to get wound infections, needed fewer painkillers after surgery, and spent less time in the hospital after surgery. The main problem with the laparoscopic approach is that it takes longer to do the surgery.
In centers where there is no availability for appendix surgery, antibiotics may be prescribed. However, studies have found that with just antibiotic treatment, up to 35% of patients can get readmitted with severe abdominal pain and recurrent appendicitis. With every admission, the risk of complications rises.
Studies have also found that individuals who undergo surgery sooner rather than later have a lesser chance of developing complications. Those who wait for 36 hours or more have a higher risk of developing a perforation of the appendix.
This means that the appendix can develop a hole in it and the infected material can spread into the abdominal cavity. This risk is around 16% to 36% in the first 36 hours. With every passing 12-hour period, the risk of perforation increases by 5%.
It is therefore strongly advised that patients undergo surgery as soon as possible once the diagnosis has been confirmed.
If the problem is caught early and treated, the surgery is usually safe and the patient will feel better in 24 to 48 hours. Patients who come to the hospital with advanced abscesses, sepsis, or peritonitis may have a longer and more complicated course, and they may need more surgery or other treatments.
Complications Of Appendicitis
As I have mentioned above, the main risk is that of the perforation of the appendix. This risk is higher in elderly patients and young children and research has found that the rate can be up to 97% when the diagnosis is delayed.
Sometimes, the appendix can remain inflamed and cause niggling pain all the time. This is called chronic appendicitis. Some of us call it a grumbling appendix.
Those who present to the doctor late can develop a mass over the appendix. This appendix mass can be very painful and additional investigations may need to be done to exclude cancer of the appendix.
Finally, an inflamed appendix that is not operated upon, can become a small collection of pus. This is called an appendix abscess. Patients who have this condition can have a high fever, and high heart rate and blood reports can be quite abnormal.
Removal of the appendix is called appendicectomy. It is usually performed as a laparoscopic procedure, but in patients who developed complications or in whom the appendix can be difficult to reach, open surgery will be offered.
Laparoscopic surgery has the advantage of having a lesser chance of wound infections, reduced hospital stay duration and patients can return to work a lot sooner when compared to open surgery.
Infection of the surgical wound after the appendix has been removed is a small complication seen in less than 5% of patients who undergo a simple appendicectomy.
Collection of pus in the abdomen which is called an intra-abdominal or pelvic abscess is another complication that is rare.
Acute appendicitis is a medical emergency. Timely treatment can prevent complications and prolonged hospital stays.