Overview The appendix is a normal true diverticulum of the caecum that is prone to acute and chronic inflammation. Acute appendicitis is the most common surgical emergency. Lifetime risk: 1 in 15 people. Can occur at any age but peak 10 – 30 years. Slightly more common in males. Acute appendicitis is rare before age 2 as the appendix is cone shaped with a larger lumen.
Appendicitis: Inflammation of the appendix
Uncomplicated appendicitis: Acutely inflamed, phlegmonous, suppurative, or mildly inflamed appendix with or without peritonitis
Complicated appendicitis: Includes gangernous appendicitis, perforated appendicitis, localised purulent collection at operation, generalised peritonitis and periappendiceal abscess
Appendectomy (appendicetomy): Surgical removal of the appendix. A standard treatment for appendicitis. A ruptured appendix is considered a medical emergency. Appendicetomy can be either done open or laproscopic.
Clinical Presentation Classically periumbilical pain that moves to the right iliac fossa. Anorexia is an important feature; vomiting is rarely prominent – pain normally precedes vomiting in the surgical abdomen. Constipation is usual. Diarrhoea may occur.
Examination 3 classic maneuvers:
Differential Diagnosis based on age
|Remember For female patients rule out ectopic pregnancy and ectopic rupture.|
|Remember Acute Appendicitis is a clinical diagnosis and is addressed surgically. When there is a high degree of clinical suspicion, an appendicectomy can be performed without imaging|
Diagnosis Armando score (TRAMLINE)
|Remember Acute appendicitis is essentially a clinical diagnosis|
Prompt Appendicectomy. Laparoscopy has diagnostic and therapeutic advantages. It is not recommended in cases of suspected gangrenous perforation as the rate of abscess formation may be higher.
|DIFFERENCE BETWEEN LAPAROTOMY AND LAPROSCOPY|
When Laproscopy is not available
|Benefits||Earlier resumption of liquid and solid intake
↓Duration of postoperative hospital stay
↓Postoperaitve pain and better cosmetic result
↓Overall complication rate including postoperative ileus
↓Incidence of wound infections
|↓Incidence of intra-abdominal abscess formation
↓Incidence of intraoperative complications
↓Operative and Inhospital Costs
|Risks||Adhesions||Predisposing to a future right sided direct hernia|
Most frequently found incidentally found in the appendix postappendicectomy. Comprise 85% of all appendiceal tumours. If <1cm in diameter, it is considered cured by appendicectomy. If >2cm in diameter (rare), investigate for spread to sentinel lymph nodes. Managed by hemicolectomy.