Appendicitis is a condition in which the appendix, a small inconsequential appendage to the colon, becomes inflamed and swollen.
Most people mistakenly believe that appendicitis is a thing of the past, thanks to antibiotics. In fact, appendicitis is still a common problem that can only be treated surgically. Antibiotics may, however, help a patient recover from surgery with fewer complications.
Located on the lower right side of the abdomen, the appendix - a small tube that extends from the large bowel - seems to serve no useful purpose in the body. Most people are not aware of this organ unless it becomes inflamed. Although waste matter from the bowel flows past it, the appendix's own mucous secretions normally keep it clean.
The swollen appendix, filled with pus and fluid, may block off its supply of blood. With its blood supply cut off, the wall of the appendix weakens and sometimes ruptures. This is called a perforated appendix. The pus that breaks through may infect the abdominal cavity or cause an abdominal abscess. In some patients, particularly infants and children, the interval between onset of pain and perforation may be a matter of hours.
Appendicitis can occur in persons of any age, but it is most prevalent in young adults. It tends to occur on its own with no particular cause.
The pain may begin on the lower right side of the abdomen, but it may also start as a vague discomfort in the center of the abdomen and then move to the lower right side. Although not every pain in the abdomen indicates appendicitis, a person should report any pain that persists and that is accompanied by loss of appetite, nausea, vomiting, and fever to a physician. Until a doctor determines what is wrong and what should be done, a person should not take laxatives or enemas.
There are no specific tests for appendicitis, but blood tests (such as a white blood cell count) and x-rays may help a physician make a diagnosis. Abdominal ultrasound has proven to be useful in differentiating causes of abdominal pain.
Physicians can perform a laparoscopy by placing a thin telescope-like instrument through a small incision in the abdomen. This enables a physician to view the abdominal organs directly. If the cause of pain is appendicitis, the physician will usually remove the appendix immediately. However, if the appendix is abscessed, the patient may have to take large doses of antibiotics to reduce infection before the appendix can be removed.
The surgery that corrects appendicitis, called an appendectomy, is a procedure with relatively little risk. Normally, the patient stays in the hospital for less than a week and can usually count on being back to a normal routine in three weeks. Many surgeons are performing laparoscopic appendectomy in which the appendix is removed through three small incisions (less than half an inch long) using special instruments and a special camera. With laparoscopic appendectomy, most patients can go home within 24 hours of the operation. However, if the appendix is ruptured, the patient may need to stay in the hospital for a considerably longer period of time and the risk of complications is much greater. A very ill patient may require special measures, such as stomach tubes and intravenous medications. If such complications have occurred, it may be two to three months before the patient can resume normal activity. Once the useless appendix is removed, there is no danger of appendicitis recurring.
Minimally invasive surgery performed with the aid of a tiny camera threaded into the abdomen has transformed some forms of abdominal surgery. For example, 80 to 90 percent of gallbladder operations are done using laparoscopy. Now a number of doctors are using the same technique to remove the appendix.