Appendicitis

The appendix (blind intestine) is a tubular organ 6-9 cm in lent, which is located at the beginning of the large intestine, in the lower right part of the abdomen. It contains lymph tissue and can produce antibodies, but its function is not known exactly. What is known for certain about it is that we can live without it.

Appendicitis is the acute inflammation of the appendix. It is the most common cause of acute abdominal syndrome (abdominal disease that requires urgent surgical intervention). It is an emergency condition that needs to be surgically removed without delay. If left untreated, the appendix may burst and the infection spreads to the inside of the abdomen. It may eventually result in death due to inflammation of the abdominal membrane (peritonitis).
One out of every 15 people suffers from appendicitis. Although it can be seen at any age, it is rare among children under the 2 years of age and is most common between the ages of 10 and 30.

SYMPTOMS AND FINDINGS

Its main symptoms include abdominal pain, loss of appetite and vomiting. The combination of these makes the diagnosis easier.

Abdominal pain is the most important symptom of appendicitis that usually starts around the navel or on the stomach. It is a blunt pain that can be aggravated and alleviated but never completely goes away. The surgical procedure usually takes 4 to 6 hours (it may range from 1 to 12 hours). The pain then settles in the lower right region of the abdomen. In some patients, the pain starts and settles in the right lower quadrant. Depending on the different locations of the appendix, the pain is likely to be felt in the back, in the right or left groin, or on the bladder and anus. If the patient consults the Doctor late and the appendix perforates, that is, it bursts, the pain  goes away for a short time. If the neglect continues, the development of abscesses in the abdomen also includes fever and then a new process begins, in which more serious complications may develop, such as portal pyemia that is also colloquially known as presence of microbes in the blood.

Loss of appetite is a sign observed earlier than pain in 90-95 percent of patients, but it is not ignored.

Nausea and vomiting are an important indicator. Nausea is observed in 75 percent of patients.

CAUSES

It occurs as a result of luminal obstruction of the blind-ending appendix (at the opening of the cavity that empties into the large intestine) mainly due to fecalith, which increases the pressure of the fluid in the appendix and leads to the development of infection by multiplying microorganisms on this ground.

DIAGNOSIS

The most important parameters in the diagnosis of appendicitis include the patient’s history of complaints and the findings obtained by the surgeon, who made the evaluation, during the physical examination. Diagnosis can sometimes be very difficult, no template is available for the diagnosis, and it can be observed in many different ways.

Examination

During palpation, SENSITIVITY develops in the lower right part of the abdomen, and stiffness (DEFENSE) is felt in the abdominal wall as a result of the contraction of the muscles in the abdominal wall as a protection reflex to pain. When the hand is pressed on the painful area for 3-4 seconds and suddenly withdrawn (REBOUND), the pain intensifies. This is an important finding for the diagnosis of abdominal disease, which requires urgent surgical intervention.

Laboratory

Laboratory findings are just supporting parameters for the general surgery specialist in the diagnosis of the disease. The safest way of diagnosing the disease is still based on the findings obtained from the examination by the general surgery specialist.

  • The number of white blood cells (LEUKOCYTES, WBC) increases in the presence of appendicitis.
  • Abdominal ULTRASOUND(USG) is performed. In case of appearance of the appendix (alone or with an accompanying disease), the place of USG in the diagnosis of appendicitis is significant; but even if appendicitis has not been observed, this does not necessarily mean that it does not exist.
  • COMPUTED TOMOGRAPHY (CT) of the abdomen can be performed. As in USG, its appearance supports the presence of the disease, but this does not necessarily mean that it does not exist when it has not been observed.

When diagnosing appendicitis, it is necessary to pay attention to the fact that it can be confused with the following conditions:

  • ¨ Extrauterine pregnancy and other gynecological diseases such as adnexal (ovary and tube) problems;
  • ¨ Urinary tract disorders;
  • ¨ Inflammation of the lymph nodes in the abdomen (mesenteric lymphadenitis)
  • ¨ Inflammatory intestinal diseases
  • ¨ Diverticulitis (bubbles that develop in the intestinal layers)
  • ¨ Gastric and intestinal perforations.

PREPARATION

If the patient has suspicions about the disease or if he/she has been informed of a suspected appendicitis by his doctor, he/she should completely stop oral food and fluid intake immediately. He/she should definitely avoid taking painkillers in order not to mislead the doctor’s assessment during the examination Despite being rare, applications such as putting a hot water bag on the painful area or similar hot applications should be avoided.

TREATMENT

For acute and perforated (punctured) appendicitis, surgery is the only way of treatment. For PLASTRONE (inner peritoneum and intestines adhered to appendix and formed a ball) appendicitis, on the other hand, the patient is hospitalized before the surgical intervention, 4-5-day antibiotic therapy is administered, and if there is no any extra problem, surgery can be scheduled to be performed after 6 to 8 weeks, when a surgically safe floor develops in the problem area.

The operation is performed using the classical open technique and closed (laparoscopic) technique.

Classic Open Technique: The lower right region of the abdomen is accessed through a 3-4 cm incision. The vascular structures of the diseased blind intestine are tied, separated from its root attached to the large intestine, and taken out of the abdomen. After controlling the bleeding, the opened wound layers are closed with sutures.

Closed- Laparoscopic Technique: In this procedure, CO2 gas is injected into the abdomen with a needle inserted through a point above the navel, in order to inflate the abdomen with about 4 liters of gas. The inside of the abdomen is evaluated by means of a tube placed above the navel and a lighted camera passed through it. If there is no obstacle to laparoscopic intervention, 2 more tubes are inserted through a 1 cm incision, the blind intestine is separated from the vascular structures, it is separated from the root, where it is attached to the large intestine, by using special instrument, and it is then removed from the abdomen. After the bleeding control, the CO2 gas is discharged and the incision sites are closed with sutures.

After both methods, if there is no extraordinary situation, the patient stays in the hospital overnight, and he/she is discharged the next day. It is recommended to avoid heavy exercises, sports, and lifting things of 10 kg or more for a period of up to 1 month.

Closed- Laparoscopic Technique
It is more advantageous than the classical open technique for many reasons including;

  • ¨ Cosmetic wellness
  • ¨ Less wound infection and herniation
  • ¨ Less postoperative pain
  • ¨ Returning to daily life and work earlier
  • ¨ Ability to detect the presence of non-appendicitis diseases.


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