Appendicitis refers to an acute inflammatory process involving the appendix, which is a small, worm-like appendage of the first part of the colon, writes Dr. Jason Roland, co-director of minimally invasive and laparoscopic surgery at Good Samaritan Hospital in Baltimore, Maryland. Anyone with an appendix is at risk for developing it. Here's how to spot and treat the condition:
•Appendicitis occurs when the single orifice leading into the appendix becomes clogged, either with stool (known as a fecalith) or by swelling in the surrounding immune tissues (more common in children). This leads to a bacterial overgrowth within the appendix, with subsequent inflammation and distension. If left untreated, this could eventually lead to rupture of the appendix, either leading to an abscess or diffuse peritonitis (inflammation of the entire abdominal cavity).
•The highest incidence of appendicitis is seen in teenagers and those in their 20s. It is seen somewhat more commonly in males. It is rarely seen in very young children or the elderly.
•Acute appendicitis often presents with a typical progression of symptoms. Generalized, vague abdominal pain is usually the first symptom, often centered around the navel. This might be accompanied by nausea, vomiting and a lack of appetite. Over time, the pain becomes more sharp and focused in the lower right abdomen, which is where the appendix is located. Fever may occur as the infection worsens. On physical examination, there is often tenderness to pressure applied over the right lower abdomen.
Sometimes the history is not so typical. Early symptoms are nonspecific and could be caused by a variety of other causes such as gastroenteritis and gynecologic issues in women.
•The treatment involves a combination of intravenous antibiotics and surgical removal of the appendix under general anesthesia. This can be accomplished either through a traditional, larger incision over the area of maximal tenderness or using minimally invasive laparoscopic techniques through the navel. In either case, the appendix is divided from its connections to the colon and its blood supply, then is completely removed. Patients are usually observed in the hospital for 24 hours after surgery, then may return home to recover.
In certain cases where the appendix has already ruptured, the infection might be initially managed nonoperatively due to a higher risk of potential surgical complications. This involves administration of intravenous antibiotics and/or placement of a radiologically guided temporary drain in order to evacuate infected fluid. Removal of the appendix after resolution of the acute infection is then planned in 4 to 6 weeks.
•The risk of complications increases depending on the severity of infection and whether rupture of the appendix has occurred. As with all surgery, there is risk of bleeding and injury to other structures within the abdomen. Risks of infection range from postoperative abscesses in the abdomen to wound infections, but these are relatively uncommon. The vast majority of patients do well and are able to return to regular daily activities within 1 to 2 weeks.