(Monday, 24th Nov, 2014)
The appendix is a small worm like pouch, which is attached to the lower end of the caecum. The caecum is the first part of the colon or large intestine. It is located in the right side of the abdomen. When the appendix becomes inflamed, the condition is known as appendicitis.
In the vast majority of cases, no specific reason for the inflammation can be pinpointed. When the appendix is surgically removed occasionally one finds that it is blocked with faecal material. This suggests that the entrance to the appendix being blocked may have triggered the inflammation.
While appendicitis can happen at any age, most cases are between the ages of seven and 25. It is very rare for a child under two to have an inflamed appendix and it is also rare among the elderly. In Ireland, appendicitis is one of the most common causes of stomach pain requiring emergency surgery among young people.
The symptoms of appendicitis may vary, but pains in the stomach are always associated with the condition. It usually begins with upper abdominal pain which gradually moves downward to the lower right quadrant of the abdomen. This process can evolve over several hours and coincides with a gradual increase in the severity of pain. Eventually the pain intensifies to the point that medical assistance must be sought.
Other signs to watch out for include:
Appendicitis is diagnosed by physical examination. The GP will usually detect tenderness in the wall of the abdomen directly over the location of the appendix. A sample of urine and blood will usually be taken for analysis. Further investigation is not usually required.
The treatment for acute appendicitis is surgical removal. This is performed under general anaesthesia. A short incision is made in the lower right quadrant of the abdomen on a line parallel with the groin crease. The appendix is manually removed through the incision and the opening is stitched up with surgical thread. The thread may be of dissolvable material, which does not need to be removed subsequently. Alternatively non-dissolvable thread or surgical clips may be used which need to be removed approximately one week later.
Increasing numbers of appendicectomy (removal of the appendix) are performed through 'keyhole' surgery. This involves the creation of a smaller surgical incision and results in speedier postoperative recovery. It is likely that this will become the surgical procedure of choice in most uncomplicated appendicectomies of the future
A two to three-day hospital stay is all that is required. It may be even less for the keyhole procedure. The patient is allowed home when their temperature and bowel function returns to normal. Provided there are no post operative complications, normal duties can be resumed after a four-week period of convalescence.
Roughly one-fifth of all patients who undergo surgery for appendicitis are found to have a ruptured or perforated appendix. This can cause a condition known as peritonitis, which is an inflammation of the membrane surrounding the internal organs. The membrane is known as the peritoneum.
Nowadays, peritonitis can be successfully treated with antibiotics, although there is a still a slight risk that an abscess may form in the abdominal cavity. If this happens, it will have to be carefully drained and the patient will be required to remain in hospital.
Some people may develop extra internal scar tissue at the site of the removed appendix. This scar tissue is known as an adhesion. The adhesion may stick on to nearby segments of intestine resulting in obstruction of those segments. Obstructions may release themselves in a short space of time but can persist and result in complete obstruction of the intestine, which is a surgical emergency. Obstruction of the intestine following appendicectomy is not a common complication.
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