What is the appendix?
The appendix is a 3 - 5 centimeter tubular structure which is connected to the cecum, the first part of the colon. The purpose of the appendix isn't known, but it does not aid in digestion and there are no side effects of having it removed.
What is appendicitis?
Appendicitis is when the appendix becomes inflamed. This happens when the opening to the appendix becomes obstructed, or blocked, usually by stool or by swollen lymph tissue. In older people, cancer can sometimes cause the obstruction.
Appendicitis is the most common abdominal surgical emergency - 250,000 appendectomies are performed each year in the United States. The lifetime risk of having appendicitis is 7%. The peak age of occurrence is between 10 - 30 years.
What are the usual symptoms of appendicitis?
Appendicitis begins as abdominal pain, frequently around the belly button. This pain then moves to the right lower abdomen and is usually constant. Nausea is frequently present with occasional vomiting. A low-grade fever may also be present.
How is appendicitis diagnosed?
Appendicitis is diagnosed by an experienced doctor based upon the history that the patient gives as well as the examination that the doctor performs. If these are inconclusive, then a CT scan is usually ordered. The symptoms of appendicitis can be similar to several other conditions, which sometimes makes the diagnosis difficult.
How is the appendix removed?
The appendix can be removed through an open operation or performed laparoscopically. In the open procedure, a 3 - 4 cm incision is made in the right lower abdomen, just over the appendix. The appendix is then divided at its connection to the colon. When done laparoscopically, there are 3 very small incisions used to insert instruments and a camera.
There are benefits to both the open and laparoscopic procedure. Surgeons decide on a case by case basis which procedure is best for the patient.
What if my appendix is ruptured?
The longer the appendix is inflamed, the more likely it is to rupture. Once symptoms have been present for 36 hours, about 50% of patients will have had their appendix rupture. At 48 hours, this reaches 75%. When this occurs, there are more likely to be complications, including wound infections, intra-abdominal abscess, and ileus (bowels are slow to return to normal function after surgery). Sometimes the surgeon will leave a drain in the abdomen postoperatively. Frequently antibiotics are needed for an extended period of time.
What is the usual postoperative course?
For patients that have their appendix removed before it ruptures, the recovery is usually quite rapid. Patients can return to eating the day of surgery or the next. Extended antibiotics are usually not needed. Within 2 - 3 weeks, patients are usually back to their normal activities.
Are there other reasons that the appendix may need to be removed?
Rarely the appendix can develop a cancer. When this occurs, it frequently presents as appendicitis. This usually requires that part of the colon also be removed.