Appendicitis is an inflammation of the vermiform (which means “worm-like”) appendix, a finger-like appendage to the cecum, the first part of the large intestine, located in the lower right side of your abdomen. The inflammation results from a bacterial infection that causes the appendix to swell and fill with pus.
Symptoms
An early symptom of appendicitis is an intermittent pain in the navel region. This becomes more severe and, usually within hours, localizes to the lower, right side of the abdomen. The abdominal muscles tighten, and the person loses his or her appetite and becomes nauseated. A slight fever is usual, as is constipation. (The inflammation, however, may on occasion trigger diarrhea.) The lower abdomen is tender; touching or pushing increases the pain. Many people will note that the pain is made worse by being bumped or jarred; particularly when riding in a car, going over bumps in the road. Appendicitis is a common condition (1 to 2 cases per 1000 people annually). Males between ages 10 and 30 are most commonly affected, but we have had patients even in their 90’s with appendicitis.
Diagnosis
The diagnosis of appendicitis can often be made based on the patient’s description of the pain, coupled with the expected findings on examination of the abdomen. In many cases, a CAT scan of the abdomen will help to confirm appendicitis as the source of the symptoms, as well as rule out other problems which can mimic the symptoms of appendicitis.
Treatment
Some cases of appendicitis are associated with atypical symptoms, and some patients with the typical symptoms actually have other disorders. So, if appendicitis is suspected, a surgeon should be consulted promptly. If the surgeon suspects appendicitis, an operation will often be recommended. However, there is published data supporting a nonsurgical approach for some less advanced cases of appendicitis. We offer a nonsurgical approach when appropriate.
At DeKalb Surgical Associates, if surgery is recommended, most cases of appendicitis are managed with laparoscopy. This procedure involves placing a scope with an attached television camera into or near the navel. The appendix can usually be easily visualized, and if inflamed, it can usually be removed without the traditional three-to-five-inch incision. For the typical patient, the hospital stay is less than 48 hours, though more complicated cases will require longer stays. Potential complications following appendectomy include persistent infection in the abdomen even after appendix removal, infection extending to the incisions used for the surgery, and post-operative bleeding, among others.
If a nonsurgical approach is advised, management consists of antibiotics, and monitoring of symptoms. Some patients do not respond adequately to this method and might still be advised to go ahead with surgery. If there is a good response, about 20% may have a recurrent episode, sometimes early on, sometimes months later. For most recurrences, surgery is usually the preferred option, but the decision and recommended treatment is individualized.
Some patients with appendicitis already have an abscess around the appendix from an earlier perforation. These patients are also best treated without immediate surgery, rather, delaying an operation for some months to allow the abscess to resolve first.