The appendix, also known as the cecum, is a 6-9 cm long, tube-shaped organ located at the beginning of the large intestine. While its exact function is unknown, it is known to contain lymphatic tissue and produce antibodies; life can be sustained without it. Appendicitis, on the other hand, is an acute inflammation of the appendix. It is an emergency and requires surgery. If left untreated, appendicitis can rupture, spreading infection into the abdominal cavity. Inflammation of the peritoneum can be fatal. Appendicitis occurs in one in 15 people. While it can occur at any age, it is most common between the ages of 10 and 30.
Symptoms of Appendicitis
The main symptoms are abdominal pain, loss of appetite, nausea, and vomiting.
Abdominal pain: This is the most important symptom. It usually starts around the navel or above the stomach. It is a dull pain and may increase or decrease. However, it does not completely disappear. After pain that usually lasts 4-6 hours, the pain moves to the lower right quadrant of the abdomen. In some patients, it is seen in the lower right quadrant from the beginning. Depending on the location of the appendix, the pain may be in the back, the right or left groin, above the bladder, or in the rectum. If there is a delay in going to the doctor and the appendix ruptures, the pain disappears for a short time. With continued neglect, fever, abscess in the abdomen, and infection in the bloodstream begin.
Loss of appetite: This occurs before the pain in almost all patients. However, it is often ignored.
Nausea and vomiting: Nausea and vomiting occur in 3 out of 4 patients.
Causes of Appendicitis
Appendicitis occurs due to the blockage of the appendix lumen (the opening of the inner cavity that empties into the large intestine) mostly by fecal matter, increasing the fluid and pressure inside the cecum, and allowing microorganisms to multiply and develop an infection.
Diagnosis
In diagnosing appendicitis, the patient’s complaints and the physical examination performed by a general surgeon are important. During the examination, tenderness develops when the lower right abdomen is palpated. The person reacts to the pain with a reflex, and hardening occurs in the abdominal wall due to contractions. The pain intensifies when pressure is applied to the painful area for 3-4 seconds. This is an important finding indicating the need for emergency surgery. Laboratory findings can assist the physician in diagnosis, but they cannot replace a physical examination. Ultrasonography and computed tomography can also be used. It is important to know that appendicitis can be confused with the following diseases when being diagnosed:
- Other gynecological diseases such as ectopic pregnancy, ovarian and fallopian tube problems,
- Urinary tract disorders,
- Inflammation of the abdominal lymph nodes,
- Inflammatory bowel diseases,
- Diverticulitis (bubbles forming in the intestinal layers),
- Diseases such as stomach and intestinal perforations,
Appendicitis Treatment
If appendicitis is diagnosed or suspected, no food, including water, should be consumed. Pain relievers should not be used. Hot water bottles or similar items should not be applied to the painful area. Treatment for acute or ruptured (perforated) appendicitis is surgical. In plastron appendicitis, the patient should be hospitalized and begin antibiotic treatment before surgery. If no further complications arise, surgery should be planned for 6-8 weeks later.
Appendicitis Surgery
Surgery can be performed using either the classic open method or the laparoscopic (closed) method. In the open method, a 3-4 cm incision is made in the lower right abdomen, and the diseased cecum vascular structures are ligated. Then, it is separated from its root where it connects to the large intestine and removed from the abdomen. In the laparoscopic method, the inside of the abdomen is viewed through a 1 cm incision and evaluated on a monitor. Then, through other incisions, the cecum vascular structures are separated, and it is detached from its root where it connects to the large intestine using a special material and removed from the abdomen. Unless there are unusual circumstances, the patient can be discharged the day after either method. Heavy exercise is not recommended. The laparoscopic method is preferred if there are no contraindications, as it involves a smaller incision. Laparoscopic surgery has several advantages, including less aesthetic scarring, lower risk of infection and hernia, less postoperative pain, earlier return to daily life and work, and the ability to detect diseases other than appendicitis.
