Acute appendicitis is an inflammation of the vermiform appendix. It is a serious condition with significant complications that can lead to death, particularly when diagnosis and timely therapy are delayed. Appendicitis is a frequent cause of emergency surgery. Almost 6% of the population suffers this disease at some point in their life. Although classically it has been considered a disease of people of 10-30 years, it affects all the age groups.
The most common symptom is abdominal pain, which usually starts on the right side, very close to the navel. After the first four to six hours, the pain comes from the lower right quadrant of the abdomen. The site of pain should be considered as depending on the orientation of the appendix. Pain may be manifested towards the navel, back or pelvic region. A common symptom is lack of appetite in 50 to 90% of the time. Nausea, vomiting, diarrhea (10% of cases) are also common. Almost all patients initially suffer from poor appetite and then abdominal pain and vomiting. The findings of physical examination are decisive, especially abdominal data. In the right side of the abdomen there is intense pain, muscle stiffness and pain on decompression.
To reduce the possibility of mistake, it is necessary to know if the patient received analgesics or antibiotics, since these usually mask the profile. Appendicitis in the pediatric patient is more serious because of the high incidence of perforation and peritonitis that develops by delaying the diagnosis. In addition, the disease progresses more quickly. That is why abdominal pain in children requires better and more timely diagnosis. The appendicitis of the elderly is also serious, perhaps because these patients show few symptoms, the pain is less intense and the leukocytes are almost not increased. In addition, intercurrent diseases deteriorate the patient. Appendicitis is common during pregnancy (one in 2200). It is related to pain in a more cephalic position than normal, while remaining compatible with the migration of the cecum, from the lower right quadrant to the subcostal position, as the pregnancy progresses. Perforated appendicitis during pregnancy is accompanied by increased risk for the mother and fetus due to septic complications.
Appendectomy is currently the most common emergency surgical procedure in the world. The estimated risk of presenting appendicitis throughout life is 8.6% for men and 6.7% for women. The population most affected is between 15 and 35 years. The diagnosis of acute appendicitis is generally established by medical history and physical examination (75-90% accuracy in surgeons); however, the diagnosis is supported by laboratory and imaging paraclinical studies. Incorrect or late diagnosis increases the risk of complications such as surgical wound infection (8 to 15%), perforation (5-40%), abscesses (2-6%), sepsis and death (0.5-5%).
Surgery is the only option for an acute appendix infection.
Laparoscopic appendectomy: This technique is the most common for simple appendicitis. The surgeon will make one to three small incisions in the abdomen. A port (rubber tube) is inserted into one of the incisions and the abdomen is inflated with the gas called carbon dioxide. This process allows the surgeon to see the appendix more easily. Through another port, a laparoscope is inserted, this one looks like a telescope with a light and a camera in the tip, so that the surgeon can see inside the abdomen. In the other small openings, surgical instruments are inserted and used to remove the appendix. The area is washed with a sterile liquid to reduce the risk of a major infection. The carbon dioxide exits through the incisions and then they are closed with sutures, staples and covered with a bandage and micropore. The surgeon may begin the procedure with a laparoscopic technique and then need to switch to an open technique. The change is made for more safety.
Open appendectomy: The surgeon makes an incision approximately 6 cm long on the right lower side of the abdomen (the lower abdomen) and cuts through the walls of fat and muscle until reaching the appendix. The appendix is then removed from the intestine. The area is washed with a sterile liquid to reduce a major infection. A drainage tube or gum may be placed that goes from the inside to the outside of the abdomen. Usually the rubber tube or drainage is then removed in the hospital, it is not closed with suture because its healing will be done in second intensity, that is to say, only closed from the inside out. The wound will be closed with sutures or staples.