Appendicitis – causes, symptoms, treatment and complications. What does appendectomy look like? [WE EXPLAIN]

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The role of the appendix, this tiny piece of the digestive tract, is not entirely clear, and a person is doing quite well without it. However, when it develops inflammation, leaving this innocently named organ without surgery may result in serious complications, including death. In such a situation, it is important to make a diagnosis quickly and to carry out the removal of the appendix early.

While the junction of the appendix with the large intestine is permanent, its end can freely change its position. Most often it is located between the intestinal loops, but sometimes it travels to the pelvis, behind the caecum, or into the rectal area. Such atypical locations of the inflamed appendix are sometimes the cause of diagnostic difficulties.

It is known that the cells of the lymphatic follicles produce, inter alia, IgA class antibodies responsible for local immunity in the gastrointestinal tract.

1. More information about the structure and functions of the digestive system can be found here: Digestive system – the most important information

Just as the function of the appendix is ​​uncertain, the mechanism by which it becomes inflamed has not been fully explained. The development of inflammation in the appendix is ​​most often explained by obstruction of its lumen, although it does not occur in all cases of inflammation. The closure of the appendix may be caused by fecal calculus, lymphoid tissue growth, an infectious process, a parasite (e.g. pinworm) or a cancerous lesion of the intestine.

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Obstruction of the appendix in a short time leads to distension and pressure increase inside it, which results in ischemia. Bacteria such as Escherichia coli, Peptostreptococcus, Bacteroides fragilis or Pseudomonas, penetrate into its ischemic walls, intensifying the inflammatory reaction that spreads to the surface of the peritoneum.

As a result of the progressive process, perforation or perforation of the appendix occurs, which leads to life-threatening peritonitis and septic shock, or at best an abscess is formed around the appendix. 24% of people perforate the appendix within 20 hours of the onset of symptoms. Therefore, it is extremely important to make a diagnosis as early as possible and refer a patient with acute appendicitis to surgery to remove the appendix, i.e. appendectomy.

1. Find out more about the large intestine here: Large intestine

Appendicitis – typical and unusual symptoms

In addition to abdominal pain, common symptoms of appendicitis include:

1. reluctance to eat,
2. nausea,
3. vomiting,
4. low-grade fever,
5. increased heart rate.

This is how 60% of cases manifest themselves. The remaining 40% manifests itself atypically, which is most often associated with the atypical location of the appendix. When the inflamed appendage is located in the stagnation, the pain in the abdomen may be initially mild or, instead, there is only pain when pressing the abdomen.

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In the case of a pelvic position of the appendix, the pain may be localized on the left side, accompanied by a feeling of urgency to urinate or stool. With a high position of the cecum, it can mimic cholecystitis or duodenal perforation. A nonspecific symptom of acute appendicitis may be indigestion, abdominal distension, general weakness.

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Appendicitis – types

The name appendicitis is used to describe a wide variety of pathological changes affecting this organ. However, it should be remembered that there are several types of appendicitis:

1. acute appendicitis – is the most common type of appendicitis. It is manifested by sudden and severe pain in the abdomen on the right side. Pain worsens when sneezing, coughing or making various movements;
2. chronic (pseudo-appendicitis) – in this ailment, the symptoms appear and disappear over the course of months. Experts say there is no such thing as chronic appendicitis. The symptoms that are felt in the patient are not related to the appendix. Histopathological examinations show no confirmation of such diagnosis;
3. ulcerative appendicitis – in this case, the appendix is ​​swollen, cloudy and very red;
4. appendicitis – in this case, the appendix is ​​enlarged, tense, hyperemic and thickened. Additionally, it is filled with purulent fluid; 
5. gangrenous appendicitis – in this case, the changes occur over the entire thickness of the process. There are dark, single or multiple lesions of necrosis in the wall of the appendix. The appendix itself is brown, rotten and gives off an unpleasant odor;
6. perforation (perforation) of the appendix – leads to an abscess or periappendicular infiltration or peritonitis

What medical conditions can cause stomach pain? Check: Abdominal pain

Interestingly, the correct diagnosis of appendicitis can be difficult even for an experienced surgeon. All the more so, you should not try to self-diagnose, which involves resigning from visiting a specialist.

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The appendix – diagnosis and tests

The constellation of typical symptoms is usually enough to make an accurate diagnosis. A doctor who will admit a patient with symptoms of appendicitis first conducts a very careful interview. Before making a diagnosis, it will collect information about the onset of the disease, the sequence of disease symptoms, the coexistence of other diseases or previous operations.

After that, the doctor conducts a thorough examination of the abdomen, which may be quite unpleasant for the patient. By applying pressure to the painful areas, the doctor will be able to recognize where the focus of the pain is. In the most common cases of appendicitis, the doctor makes a diagnosis at this stage and usually sends the patient to surgery.

Additional tests – laboratory and imaging – in the case of acute appendicitis play only an auxiliary role. However, in the case of atypical localization of the appendix, as well as in young children, pregnant women and the elderly, diagnosis may be problematic. Additionally, a number of other abdominal or pelvic pathologies can mimic the picture of acute appendicitis.

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In such cases, additional tests can be of great help. When assessing the blood count in acute appendicitis, an increased number of white blood cells is found, and imaging tests may reveal signs of appendicitis.

Then, they facilitate proper diagnosis, for example by excluding other conditions that may cause abdominal pain, such as gallstone or kidney stones, diverticulitis of the caecum or sigmoid colon, gastrointestinal perforation, Meckel’s diverticulosis or pathology of the reproductive organ.

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Complications after appendicitis

Appendicitis can cause various complications. The most dangerous complication after appendicitis is its perforation, i.e. a perforation. A perforation of the appendix usually occurs on the second or third day. Sudden severe pain, increased heart rate, and symptoms of peritoneal irritation may indicate perforation.

If the appendix is ​​perforated, which is located in the adhesions inside the abdominal cavity, it may result in a periappendicular infiltration. Perforation can also lead to a free peritoneal cavity, which causes diffuse peritonitis.

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Another complication of appendicitis may be the appendicular abscess, which is a cluster of pus, bacteria and damaged tissues. In this case, the body temperature rises to 39-40 degrees Celsius, a markedly elevated heart rate and leukocytosis are noted.

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The operation itself consists of an appendectomy. It can be performed using the traditional method, with the opening of the abdominal cavity, or laparoscopically, through small incisions of the integuments. The latter method of operating is recommended especially in obese and elderly people, or when the diagnosis, despite additional tests, still raises doubts. Administration of antibiotics is most often continued for a short time after the procedure.

The purpose of performing this surgical procedure is always to confirm the diagnosis of appendicitis. Appendicitis can cause symptoms that are similar to those of other serious medical conditions.

The appendix must be removed completely, and if contaminated fluid is diagnosed in the abdomen, the abdomen must be thoroughly rinsed. Depending on the inflammation in the abdomen, the doctor decides whether to leave a drain in the abdomen or remove it.

1. More information about laparoscopy can be found here: Laparoscopy – what is this procedure?

Procedure after appendectomy

No specific medical recommendations are anticipated if the treatment of appendicitis has been successful. Due to the fact that the ridge excision is a surgical procedure, there are a few important points to keep in mind.

1. Reporting to control visits – the surgeon performing the operation should make an appointment for such a visit. During the inspection, the doctor will perform a physical examination and assess the general condition of the patient. If non-dissolving sutures were used when sewing the incision, they will be removed at the follow-up visit. At the follow-up visit, the doctor introduces the patient to the histopathological examination of the removed appendix;
2. Postoperative wound observation and care – after leaving the hospital, the wound should be monitored for good healing and signs of infection do not appear. Wound infection most often appears from the 3rd to the 7th day after surgery. If there is redness or swelling in the vicinity of the wound with purulent content, immediately contact the nearest medical facility. In this case, local treatment or antibiotic therapy is used. 
3. Observation of the patient’s health – after the surgery to remove the appendix, you may experience various symptoms which are a sign that an abscess has formed in your abdomen. If you experience high fever, abdominal pain, diarrhea or vomiting after surgery, see your doctor as soon as possible.
4. Postoperative adhesions – adhesions are glued intestinal loops or intestines that are stuck to the abdominal wall. Adhesions are the cause of mild pain, and much less often they cause adhesions in the intestines. Adhesive intestinal obstruction is manifested by severe abdominal pain, flatulence, stool and gas retention, and vomiting. If the doctor confirms the adhesive bowel obstruction, another operation will be required. Adhesive obstruction is a condition that can occur a few days after appendicitis surgery, as well as several years after the surgery. 
5. Physical activity – after the surgery to remove the appendix, you should give up sports for a period of 4 to 6 weeks. If the patient was physically very active before the surgery and lacks exercise, then immediately after the surgical wound has healed, he / she can take part in swimming pool activities. 

Diet after appendicitis surgery

After the appendix surgery, you should also take care of an appropriate menu that will support the functioning of the digestive system.

One day after the appendix removal, the patient is allowed to drink only small amounts of fluids. In this case, water, chamomile infusions or tea work well. During the day, you should not drink more than half a liter of fluids, in small doses of 20-60 ml at a time.

If no complications occur in the first day, a gruel-and-mush diet is implemented. The patient can be given small porridges boiled in water or gruels. After the first bowel movement, an easily digestible diet can include lean broth, vegetable soup, milk soup or softened wheat bread. The menu can be enriched with mashed vegetables, fruit juices or cottage cheese.

An easily digestible diet after appendicitis surgery is recommended for about 3 weeks.