The appendix is a small, finger-shaped segment that protrudes from the large intestine, close to the point where it joins the small (blind) intestine. The appendix may have an immune-like function, but it is not an essential organ. Appendicitis is inflammation of the appendix.With the exception of strangulated hernias, appendicitis is the most frequent cause of severe and sudden abdominal pain and abdominal surgery in many countries. This condition is more frequent between 10 and 30 years old.
The cause of appendicitis is not fully understood. In most cases, an obstruction within the appendix can trigger a process in which it becomes inflamed and infected. If the inflammation remains untreated, the appendix may perforate. The perforation spreads the bacteria-laden intestinal contents across the abdomen, causing peritonitis , which can lead to a life-threatening infection. Perforation can also cause an abscess to form. In women, the ovaries and fallopian tubes can become infected and the resulting obstruction can cause infertility . A perforated appendix can also cause bacteria to infect the bloodstream (a potentially deadly state, known as septicemia ).
Less than half of people with acute appendicitis have all the most characteristic symptoms: nausea and vomiting , and very severe pain in the lower right part of the abdomen. The pain may start suddenly in the upper abdomen or around the navel; then nausea and vomiting appear. After a few hours, the nausea disappears and the pain moves to the lower right quadrant of the abdomen. When the doctor presses this area, pain appears and when, suddenly, withdraws the hand, it can become more acute (positive decompression sign). Fever between 37.5ºC and 38ºC is common .
The pain , especially in infants and children, may be widespread rather than localized in the lower right quadrant of the abdomen. In adults and pregnant women, the pain is usually less severe and the area less sensitive.
If the appendix punctures, the pain and fever may increase. If the infection gets worse, shock may occur.
Diagnosis and treatment
An analysis of blood shows a moderate increase in white blood cell count in response to infection. Usually, in the early stages of acute appendicitis, tests [such as radiology , ultrasound and computed tomography ( CT )] are not helpful.The diagnosis is based on the physical examination data. To avoid perforation of the appendix, the formation of abscesses or inflammation of the lining of the abdominal cavity (peritonitis), the doctor performs an emergency surgery.
In almost 15% of the interventions made with the diagnosis of appendicitis, it was, after all, a normal appendix. However, if the surgery is delayed until the cause of the pain is certain, the consequence can be deadly: an infected appendix can perforate in less than 24 hours after the onset of symptoms. Even if the appendix is not the cause of the procedure, the surgeon usually extracts it. Then he examines the abdomen and tries to determine the real cause of the pain.
With an early surgical intervention, the chances of dying are very small. The patient can usually leave the hospital after 2 or 3 days and convalescence is usually quick and complete.In the case of an appendage perforation, the prognosis is more severe. 50 years ago, this injury was often deadly. The antibiotics have reduced the percentage of mortality almost zero, but sometimes it can take several surgeries and a long convalescence.