Appendicitis

What is an appendicitis ?

The appendix is a finger-shaped blind sac that is connected to the first part of the large intestine. As a result of an infection, it swells and can be filled with pus, it is then called an appendicitis.

If appendicitis is not treated in time, the appendix may perforate and pus may leak into the abdominal cavity. If the pus collects in one place, it is called an abscess. If the pus leaks into the entire abdominal cavity, it is called diffuse peritonitis.

Symptoms may vary according to the location and length of the appendix.

Acute appendicitis can affect people of all ages.

It mostly occurs between the ages of 10 and 30. It is very rare before the age of 2.

Diagnosing appendicitis can be difficult, as symptoms can be unspecific and tricky.

Symptoms depend on the location of the appendix in the abdominal cavity.

Examples of common symptoms (not exhaustive):

• Sudden pain in the right lower abdomen.
• Pain starting in the umbilical region, later migrating to the right lower abdomen.
• Pain in the right side of the lower abdomen when coughing, walking or during sudden movements
• Loss of appetite.
• Moderate fever (37.5°- 38.5°C) that may increase as the disease progresses
• Nausea, vomiting. Swelling of the abdomen
• Constipation, diarrhea

In pregnant women, the pain may be mainly in the upper abdomen as the appendix and the right colon are pushed upwards into the abdominal cavity under pressure from the fetus.

There are two possibilities:

1. Infection of the wall of the appendix.

• As a result of the infection, the wall swells and the appendix becomes occluded, preventing the bacteria in the appendix from draining. Bacteria trapped in the appendix multiply, forming an abscess and further inflammation of the appendix.

2. Obstruction of the lumen of the appendix

• As a result of hard stools occluding the appendix canal, the evacuation of bacteria from the lumen to the intestine is prevented. Bacteria trapped in the appendix multiply, creating an abscess and further inflammation of the appendix.

No, appendicitis cannot be prevented.

In the fetus, it produces hormones that help promote its development.

In adults, the appendix plays a role in immunity. The lymphoid tissue in the appendix increases until the second and third decade, after which it declines and disappears completely by the age of 60.

Yes, people in whom the appendix has been removed have the same life expectancy and quality of life as those who have not had surgery.

When diagnosed a few days after the onset of appendicitis, the inflammation may be so severe that surgery in the acute phase is no longer desirable.

This is because as a result of the inflammation that has already persisted for several days, the tissues around the infected appendix are highly edematous and stick to the appendix to contain the local infection. At this stage, it is difficult to distinguish the different structures and organs stuck together in the abdominal cavity to contain the infection. Dissection of the fused tissues can lead to perforation of organs (e.g. large and small intestines) and severe bleeding.

At this stage, the risk of complications from surgery may become greater than when treating the appendicitis with antibiotics. In these cases, the appendix is treated with antibiotics and, if necessary, with (percutaneous or surgical) drainage of the abscess without removing the appendix.

After at least six weeks, appendectomy can be performed. If the patient is older than 50 years or if other pathology is suspected in the appendix, a colonoscopy is performed before surgery to rule out the presence of a tumor in the large bowel.

Conservative treatment:

Conservative treatment with antibiotics with or without drainage of the abscess

• In the presence of an appendicular phlegmon: General inflammation around the appendix making surgical removal of the appendix more likely to cause complications.
• If a small appendicular abscess is present or in case of percutaneous drainage of the abscess.

Treatment:   

– Light diet

– Intravenous antibiotic in hospital:

Examples:  Ciproxin® + Flagyl® + (Amukin®)…

– Oral antibiotics at home:

Examples: Ciproxin® + Flagyl® + (Amukin®)..:  Ciproxin® +Flagyl®, Augmentin®…

– Laparoscopic appendectomy

An appendectomy is the removal of the appendix.

See surgical procedure : Laparoscopic appendicectomy