Appendicitis: A Medical Emergency

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Appendicitis is cited to be the most common cause of acute abdominal pain that is referred for an emergency surgical procedure in the United States. It usually occurs in people in their second or third decades of life with males and females more or less equally affected. However, perforation of the appendix, which leads to a more serious complication or even mortality, is highest during infancy and old age.

Appendicitis is believed to be the result of an obstruction in the appendiceal orifice that leads to the distention of the lumen. This is most commonly caused by a fecalith, which is a mixture of fecal matter and vegetable fibers. In addition to the increased pressure inside the appendix, the obstruction in the lumen makes it favorable for luminal bacteria to multiply and invade the appendiceal wall, leading to venous engorgement and arterial compromise. If left untreated, gangrene and perforation of the appendix may occur, leading to septicemia as its contents are spilled over into the peritoneal cavity.

Occasionally, acute appendicitis may be the first manifestation of Crohn’s disease.

Causes of Appendicitis

As mentioned above, appendicitis is most commonly caused by the obstruction of a fecalith. Other causes of obstruction are enumerated below:

  • Tumors (i.e. carcinoma, carcinoid)
  • Gallstones
  • Parasitic worms (i.e. Enterobousvermucularis)
  • Foreign bodies
  • Enlargement of the lymphoid follicles secondary to:
    • Bacterial infection
    • Viral infection (i.e. Salmonella or Measles)

However, studies have shows that in almost half of the patients, no obstruction is seen upon surgical removal of the appendix and the cause of the appendicitis in these patients is unknown.

Signs and Symptoms of Appendicitis

Acute appendicitis is often referred to as a masquerader, as there are a lot of differential diagnoses to consider, especially in women, when the patient presents with abdominal pain. Some signs and symptoms pointing to appendicitis are as follows:

In appendicitis, pain begins around the navel then moves to the lower right quadrant
In appendicitis, pain begins around the navel then moves to the lower right quadrant
  • Cramping, diffuse pain that begins below the sternum or around the umbilicus then radiates to the lower right abdomen
  • Point tenderness at the lower right quadrant or at the McBurney’s point
  • Pain that is more severe when moving, coughing or sneezing
  • Nausea
  • Vomiting
  • Low grade fever
  • Loss of appetite
  • Constipation or diarrhea
  • Abdominal bloating

It is important to note that the manifestation of appendicitis in young children and in very old patients may produce only vague and the diagnosis is often only made when perforation ensues.

Treatment of Appendicitis

The main treatment goal for appendicitis is surgical removal of the inflamed appendix or appendectomy. Two kinds of appendectomy may be performed – an open surgery or a laparoscopic surgery. An open surgery makes use of a larger abdominal incision to remove the appendix. This procedure entails a longer recovery time but is indicated when the appendix has already ruptured wherein the surgeon needs to clean up the abdominal cavity. In contrast, a laparoscopic surgery makes use of smaller incisions to insert surgical tools and a camera for the surgeon to navigate inside. This allows for the patient’s faster recovery and often heals with minimal pain and scarring.

Appendicitis is a medical emergency that is characterized by severe lower right abdominal pain and necessitates surgical removal of the appendix.

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