About Appendicitis

Appendicitis is a frequent surgical emergency, with a worldwide age-adjusted rate of about 229.9 per 100,000 people. It most often affects those aged 15–19. The lifetime likelihood is 8.6% in males and 6.7% in females.

What is Appendicitis?

Appendicitis refers to inflammation of the appendix a small sac attached to the large intestine. It usually occurs when the appendix is blocked by stool, infections, or other factors, leading to pain, swelling, and potential rupture. It is a critical condition that typically needs surgical treatment without delay.

Appendicitis Symptoms

• Fever: Around 40% may experience fever, suggesting a strong immune response or advancing infection.
• Malaise: General discomfort, tiredness, or feeling sick can occur, similar to common illness.
• Abdominal bloating: The stomach might look puffy, hinting at advanced appendicitis or rupture.
• Urinary issues: Some may feel an urge to urinate more frequently due to nerve irritation.
• Constipation or gas retention: Reduced bowel activity may cause blockage, pressure, and relief-seeking strain.
• Diarrhea: In some, the colon near the appendix becomes irritated, causing loose or frequent stools.
   

Appendicitis Causes

Because the appendix is narrow and close to the colon, it is prone to blockage and infection. Colon bacteria can multiply in a trapped appendix, causing inflammation.
Frequent causes include:

• Fecaliths or appendix stones: Hardened stool that blocks the opening, trapping bacteria inside.
• Lymphoid tissue swelling: The immune system’s lymphatic tissue in the appendix can swell in response to infections elsewhere.
• Colitis: Inflammation from infection or bowel disease may spread to the appendix.
• Other triggers: Tumors, parasites, or genetic disorders like cystic fibrosis may also lead to obstruction.
   

Appendicitis Complications

• Ischemia and necrosis: Swelling can cut off blood supply, leading to tissue death.
• Gangrene or rupture: As tissue decays, it may lead to gangrene or bursting of the appendix.
• Abscess or phlegmon: Infection may localize into a pus pocket (abscess) or inflamed tissue mass (phlegmon).
• Peritonitis and sepsis: If infection spreads in the abdomen or bloodstream, it can result in fatal sepsis.
   

Appendicitis Diagnosis

Diagnosis combines physical assessment, lab findings, and imaging.

• Clinical history and exam: Right lower abdominal pain, rebound tenderness, and muscle guarding are key signs.
• Bloodwork: Raised white cells and CRP suggest infection or inflammation.
• Urine and pregnancy tests: Used to exclude other conditions like UTI or ectopic pregnancy.
• Ultrasound: Safe first option, especially for kids or pregnant women.
• CT scan: Common in adults, highly accurate but involves radiation.
• MRI: Preferred for inconclusive cases in pregnant women and children.

Appendicitis Treatment Options

Appendectomy (Surgical Removal)

• Advanced Laparoscopic Appendectomy:
  
  • How it’s done: Small incisions are made for camera-aided removal.
  • Benefits: Reduced recovery time (1–2 weeks), less pain, and smaller scars.
• Open Appendectomy:
  
  • How it’s done: A single larger incision is made in cases with severe infection or complications.
  • When used: Best for ruptured appendix or when there's an abscess.

Percutaneous Drainage

For Abscess: Involves CT-guided fluid drainage followed by later surgical removal.