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Published by on Wednesday, December 24, 2014 at 10:55:00 AM

Why and How the Operation of the Appendix - appendicitis?

Appendix or AppendicitisArticle source - Operations on the appendix amongst the commonest and important surgeries. The appendix, an organ situated near the end of the small intestines, gets swollen and causes severe pain in the abdomen and needs to be removed by operation. Sometimes, due to misdiagnosis on part of the treating doctor or due to fear of the surgery, the operation is not performed at the appropriate time, this can endanger the patient’s life. On the other hand, there are many a Surgeons who under the guise of any abdominal pain knock off the appendix for monetary gains. To avoid this, the general public needs to be educated to some extent about this simple and common disease.

Where does the appendix lie and what is its function ?

The appendix is a worm-like appendage situated in the lower right part of the abdomen at the junction of the small and the large gut. This 1"-5" organ is present in all humans since birth. It is not an organ that is formed later on as is the common misconception. This organ plays no role either in the digestion of food nor any other function. It is a ‘vestigial’ organ.

Why does the appendix get inflamed ?

Appendicitis means swelling of the appendix. Its exact cause, though, is not known fully, but the swelling can occur due to two causes. 1) Non-obstructive: Due to infection, the whole appendix gets affected. But the swelling does not increase rapidly and many times it reduces on its own or due to the medicines given by the doctor. This can occur repeatedly. There is minimal risk of appendicular rupture. But it does result in the formation of adhesions between the bowels and the protective fatty layer resulting in the formation of a mass or lump. 2) Obstructive : Due to fecoliths or worms, the lumen of the appendix gets blocked. This results in severe swelling, which can increase rapidly and without timely surgical intervention, can result in the rupture of the appendix. This can form a localized collection of pus or the pus can disseminate all over the inside of the abdomen and can result in a very serious condition of the patient.

What are the signs and symptoms of appendicitis ?

It can affect males and females of all age groups, but is commoner in the 10-30 years age group. The prognosis is especially worse below the age of 2 years and above the age of 90. At first, there is a sudden onset of abdominal pain. The pain is initially above the umbilicus in the center, and later moves to the right and below the umbilicus. The pain gradually worsens and can be associated with loss of appetite, nausea and vomiting. Fever too can set in. In this manner, abdominal pain, vomiting and fever in that order should make one suspect appendicitis. Examination of such patients always manifests certain signs. The pulse rate is increased due to the fever. When the right lower side of the abdomen is pressed, there is pain and the muscles appear rigid. Do not massage the abdomen when such pain occurs and do not take strong purgatives.

What tests are done to confirm the diagnosis ?

Many of the tests enumerated below are done on an emergency basis to rule out other causes of abdominal pain and to confirm the diagnosis of appendicitis. Blood tests : In case of appendicitis, there is a rise in the white blood corpuscle count. Urine examination : If there are red blood cells or pus cells in the urine, then there is a possibility of kidney stone or urinary infection. Stool examination : If there is infection in the intestines, then cysts of the organisms may be seen. Plain x-ray of the abdomen : The swollen appendix is not seen, but if it has ruptured then gas may be seen under the diaphragm and also renal stones may be detected if present. Sonography of the abdomen : Sometimes, a severely swollen appendix may be seen. Pus may be seen collected around a ruptured appendix. Other causes of abdominal pain in that area can be made out e.g.: right ureteric stone, in females swelling of the right tube or ovary. Laparoscopy : The need for this may be felt in young women. Nowadays, it is possible to remove the appendix by this method also. Screening has no value in the diagnosis of this condition.

What is the treatment for appendicitis ? In cases of mild attacks of non-obstructive appendicitis, sometimes medicines may be used as a temporary measure. For this anitbiotics and pain relieving injections along with I. V. drips are used. By this, an emergency surgery may be postponed and done later on at a convenient date. Repeated attacks of non-obstructive appendicitis call for planned surgery and for sudden obstructive appendicitis, emergency surgery is the best and standard treatment. Once the diagnosis of appendicitis is confirmed, then in the best interest of the patient, surgery must not be avoided or postponed, because more the delay, more is the likelihood of complications like adhesions of the bowels, mass formation, appendicular perforation, pus formation or spread of the pus all over the abdomen. There is a definite danger to the life of the patient if surgery is not done for perforated appendix. In case of females, the tube can get blocked and she may not be able to conceive at a later date.

How is the operation performed ? This can be as an emergency or can be planned. If there are no complications due to appendicitis, then the surgery is easy for the surgeon and less risky for the patient. A small 2"-3" oblique incision is taken to the right of the lower abdomen to remove the swollen appendix. This operation generally lasts 1/2-1 hour and only the part below the umbilicus is anesthetized. The patient can generally start taking liquids orally after 8 hours and can be discharged in 3-4 days and return for stitch removal on the 8th day. In case of complications, the operation is more difficult and risky for the patient. A 4"-6" long vertical incision is taken on the right side of the abdomen. The blackened or ruptured appendix is removed and the adhered bowels have to be separated and the pus from the cavity has to be cleaned. This increases the duration as well as the extent of the surgery, which may last from 1-2 hours and sometimes may need general anesthesia. The patient has to be kept on IV drugs for about 3 days and, many times, has to remain in the hospital for 8-10 days. In this way, the patients suffer both physically as well as financially.

Are there any risks in the operation ? Due to the rapid advances in the medical field, the surgery for appendicitis is not very risky any longer but if the surgery is done after some complications set in, there is a definite increase in the risk. The wound may get infected after the surgery, though this may heal with medicines and dressings. The appendix being a vestigial organ, its removal does not permanently affect digestion, nor does the appendix recur after removal. Surgery results in a permanent cure.
Published by IzajAhmed Shaikh.
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I am, Mr. IzajAhmed Shaikh, Computer Professional, and Pro. Blogger, who belongs to Shahabad, Karnataka India. My basic Qualifications are B.Sc., and M.C.M. done from University of Pune, formerly known as, Poona University, also like to write articles based on my personal experiences.