Appendix is a small finger shaped organ present in the right lower part of the abdominal cavity. Its base is attached to the caecum which is the first part of the large intestine. The appendix doesn’t have any function in the human body although it plays a role in digestion in the lower animals. The appendix can become infected when its opening is blocked by food or faeces. The inflammation of the appendix is known as appendicitis. It usually occurs in young people between the ages of 10-25 years.
The symptoms of appendicitis include pain which usually starts in the umbilical area around the belly button and then migrates to the right lower part of the abdomen. There is associated nausea and vomiting and anorexia. This pain usually is different from pain of acidity or intestinal infection and it doesn’t get better by taking medicines. Patient may develop fever later on when the infection increases in severity. There might be severe pain and swelling of the abdomen in cases of pus formation in the appendix or when the appendix has ruptured with spread of infection in the abdominal cavity.
The diagnosis is suspected on the basis of the clinical history and the physical examination in which there is marked tenderness in the right lower part of the abdomen. The blood tests usually reveal raised white blood cell count with increase in number of polymorph cells. These are the infection fighting cells in our body and are increased in case of any systemic infection. Diagnosis is confirmed by an ultrasound of the abdomen which shows a swollen appendix. It also helps to rule out other causes of abdominal pain especially in females where the pain can be because of the infection of the uterus or ovaries. The sensitivity of ultrasound for detection of appendicitis is only around 50-60% and in cases of doubt, a CT scan of the abdomen can be done which increases the diagnostic accuracy to around 80%.
The treatment of appendicitis involves emergency surgery by removal of the appendix. Giving antibiotics alone might treat a minor infection but which is usually done by laparoscopy. If the surgery is not performed in a timely manner, there is a risk that the appendix might burst and then the infection can spread to other parts of the abdomen which may require a major operation by opening the abdomen. This increases the morbidity and leads to prolonged hospital stay and delayed recovery.
The advantages of laparoscopy include besides less postoperative pain and faster recovery, the surgeon can inspect the other abdominal organs including the intestines, uterus, ovaries, etc. and any other pathology can also be tackled simultaneously.
The patient is normally allowed to have liquids 6 hours after the surgery and started on soft diet the next day. The patient is discharged to home and can carry out all routine activities within the next 2-3 days. The patient can resume a normal diet within a week and there is no long term problem with digestion of food after this surgery.