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Appendicitis

Appendicitis is inflammation of the appendix, which is a thin pouch attached to the caecum, a part of the large intestine located in the lower right side of the abdomen. It is usually about the size of a finger. The precise function of the appendix in the human body is unknown, although it has been found to play a role in digestion for other animal species.
This condition is a medical emergency. If the appendix bursts, its infected contents will spread throughout the abdominal cavity. Infection of the lining of the abdominal cavity (peritonitis) can be life threatening without prompt treatment.

Anyone of any age can develop appendicitis, but it is more common during childhood and adolescence. It is less common for anyone over the age of 30 years. Treatment options include surgery.

Symptoms include:

  • Dull pain centred round the navel, which progresses to a sharp pain in the lower right side of the abdomen.
  • Rebound tenderness – the pain increases when pressure on the abdomen is released
  • Low grade fever
  • Vomiting
  • Diarrhoea or constipation
  • Loss of appetite.

Causes:

The cause of appendicitis is unclear, however, obstruction of the appendix cavity by food or faecal material may be a precipitating factor in the development of the condition. There is no direct evidence that diet plays a role in causing appendicitis.

Many people treated for acute appendicitis may have had previous episodes of low grade or sub-clinical appendicitis that they overcame without medical intervention.

Diagnosis

  • Appendicitis can be hard to diagnose in the early stages as the symptoms often mimic those of other disorders such as gastroenteritis, ectopic pregnancy and other infections of the kidneys or chest. Diagnosis therefore will include:
  • A patient history of the onset, type and severity of symptoms
  • A thorough physical examination which may include a rectal examination
  • Blood tests to check for a raised white cell count to indicate infection.
  • Urine tests to exclude urinary tract infections or kidney stones
  • Imaging tests such as abdominal X-Ray, ultrasound or computerised tomography (CT) scan may be ordered if diagnosis is uncertain.

Treatment

Surgery is the standard treatment for appendicitis.

However, in some cases of mild appendicitis or where the diagnosis is uncertain, admission to hospital for observation and antibiotic therapy may be the suggested course of treatment.

Surgery is indicated if the condition fails to settle spontaneously or if the risk of rupture is imminent. This procedure, which aims to remove the appendix completely, is known as an appendicectomy. Your doctor will perform the surgery under general anaesthesia. Antibiotics are often given before surgery to reduce the risk of infection.

There are two operative techniques for appendicetomy – Open appendicetomy and Laparoscopic appendicetomy with the latter now being the preferred option.

The technique for removal of the inflamed appendix will depend on your surgeons’ preference and whether the appendix has ruptured.

Laparoscopic Appendicectomy

The appendix can often be removed using laparoscopic (keyhole) surgery. Laparoscopic appendicectomy is a less invasive surgical method that uses a device called a laparoscope. The laparoscope is a small, thin tube with a light and tiny video camera (connected to a television monitor) attached at the end, which provides a magnified, lighted view of the internal organs on a high-definition monitor screen.

The surgery is performed under general anaesthesia. Your surgeon makes several small incisions in the abdomen. The laparoscope is inserted into the body through one of the incisions. The television monitor guides the surgeon in the insertion of surgical instruments through the other incisions. Carbon dioxide is pumped into the abdomen to inflate the abdominal cavity so that the appendix and other adjacent organs can be visualised easily. With the images from the laparoscope as a guide, the surgeon can look at the appendix, determine the extent of the problem and when deemed safe to do so remove the appendix. Once the appendix is removed the area is washed with sterile fluid to minimise the risk of infection. The tiny incisions are closed and covered with small dressings.

If the appendix has burst, the surgeon will insert a tube and drain the abdominal cavity of pus. Antibiotics are given to the patient intravenously to reduce the possibility of peritonitis.

Rarely an operation that starts out as a laparoscopic colectomy turns into open surgery if the surgeon encounters unexpected difficulties.

Please refer to the General Surgery "For Patients" page for more information about the open procedure.

At Casey Surgical Group Laparoscopic Appendicectomy is the preferred surgical option.

Post-operative recovery

Hospital stay is usually overnight. It is possible that a more prolonged stay may be necessary for a ruptured appendix to allow high doses of antibiotics to be given, to minimise risk of infection or control any existing infection sites. Depending on the level of activity involved it is likely that a week off work/school will be needed for recovery.

Conditions and Management

Useful Links

  • Jessie McPherson Private Hospital
  • MonashHealth
  • St John of God Health Care
  • Monash University
  • Royal Australasian College of Surgeons
  • Valley Private Hospital
  • West Gippsland Healthcare Group