Back

Appendicitis

Appendicitis is inflammation of the appendix of the intestines. Although it occurs at any age, it is the most common surgical emergency in children. As other conditions may present in ways similar to appendicitis, it is important to exclude them. Appendicitis is easily treated once diagnosed. If neglected the complications can be serious.

Description
The appendix is a tube-shaped sac attached to the large intestine. It is only 5-10 cm long but if it gets inflamed it can make its presence felt. Appendicitis is a common everyday diagnosis. It can appear suddenly or there can be background symptoms for a few days. A North American doctor was the first to describe the condition in 1886. Appendicitis probably existed before then but had simply not been properly documented. Appendicitis is common worldwide. The quality and outcome of the treatment varies according to resources available and the experience of the clinical team.

Causes
A faecolith may cause appendicitis. A faecolith is faecal material that gets stuck in the appendix rather than being excreted. The faecal material with time hardens and becomes “stone” like. The faecolith can block the appendix and this in turn may lead to inflammation and infection.

Another cause is swelling of lymphoid tissue from infection – for example viral infection. The swollen lymphoid tissue can block the appendix and cause infection as above.

Symptoms
The classic symptom of appendicitis is pain at the right groin. The pain may be so severe the sufferer will not allow the doctor to press firmly at that region. There may be a description of pain starting around the navel first and then moving to the right groin where it became more intense. Vomiting, nausea and diarrhoea may also occur but these symptoms are not specific for appendicitis. The sufferer may complain to the doctor of not being able to bend over if requested to do so.

In the West, appendicitis is the most common cause of acute abdominal pain in children. This tends to be children over 5 years old. If the doctor places a stethoscope on the abdomen and cannot hear any bowel sounds this is an ominous sign. It suggests the appendix may have burst. This is a surgical emergency as the sterile environment of the abdomen would suffer damage from the bacteria-infested bowel contents.

Appendicitis is not the only condition that causes pain at the right groin. A notable one is an ectopic pregnancy. If a woman of childbearing age develops right groin pain and she has missed a period, then ectopic pregnancy should be suspected first. It is an important diagnosis as missing it could result in serious consequences. A blocked hernia can also cause groin pain. In woman, an ovarian cyst may cause pain and in a man the origin of the groin pain may be a testicular problem.

There are other conditions associated with right groin pain but there would usually be other symptoms to help establish the diagnosis.

Treatment
The treatment for acute appendicitis is removing the appendix. Where experience and facilities permit, this is performed using keyhole surgery. As the cuts made with keyhole surgery are small, recovery is quick. If the appendix contains an abscess or if it bursts, a large cut is necessary. The appendix has no known purpose however removing it does not cause any harm.

The British Medical Journal published a study in 2012 which compared treating appendicitis with antibiotics against surgical treatment. The study concluded if antibiotics are given early in acute appendicitis that does not have any complications (e.g. abscess or perforation), the outcome is as good as having surgery.

Prevention
There is no known method for preventing appendicitis.

Appendicitis is common – say 2 in a scale of 1-5. One in 13 of us at some point in our lives is going to get appendicitis. Houdini the great magician and illusionist was no exception. He escaped from straitjackets and handcuffs but died of a perforated appendix. That was a hundred years ago. Luckily the treatment today is much better.

In: General Medicine,