What’s it?

Acute appendicitis is an inflammation of the appendix. The appendix is a vermiform structure that derives from the first portion of the large intestine. Its lengthy ranges by around 10 cm and it is located in the lower part of the abdomen. The appendix has a canal in its interior that communicates with the large intestine in which there are semifluid feces. Appendicitis is caused usually by a small block of hardened feces that obstructs the appendix.

Acute appendicitis is the most frequent cause of acute abdominal pain and is surgically treated as an emergency.

What does one experience?

Acute appendicitis, in its typical presentation, begins with pain around the navel, accompanied by nausea and occasionally vomiting. Some hours later, the pain occurs in the lower part of the abdomen, accompanied by moderate fever and appetite loss.

Appendicitis may be restricted to the inflamed organ or cause its rupture. When this happens, the body defenses usually block the infection around the appendix, originating an abscess. When the body defenses fail to block the infection, the content of the same spreads across the abdomen, leading to a severe state of acute peritonitis. In this circumstance, there’ll be intense diffuse pain, high fever and a severe toxic state, requiring immediate surgical intervention.

Acute appendicitis is a disease that prevails in the age group between 15 and 50 years, but it may occur in children and the elderly, too.

The described symptoms occur in a typical situation, the most habitual one, but frequently the disease manifestations are quite diverse, and the diagnosis may become hard to make. It’s always necessary to make a differential diagnosis for urinary calculus, other bowel disorders, cysts and pelvic infection in women, amongst other problems.

How is it diagnosed?

The diagnosis of appendicitis is made by the doctor, observing the symptoms from the findings obtained in a careful clinical examination and by supplementary tests. Among these are: hemogram, simple x-ray of the abdomen, echography, computerized tomography scanning, laparoscopy and standard urine test.

The hemogram generally shows increase in the total count of white cells.

The standard urine test, when normal, rules out diseases of the urinary tract, such as passage of calculus or infection.

The simple x-ray of the abdomen, in addition to helping rule out other diagnoses, can demonstrate the fecal material in the appendix region.

Echography is a painless, non-invasive exam that can demonstrate an enlarged appendix and presence of abscess. The appendix isn’t always visible to echography; this circumstance doesn’t rule out appendicitis though. This exam is also useful to rule out other diseases, particularly pelvic problems in women.

Computerized tomography is indicated when the symptoms aren’t typical, to differentiate appendicitis from other abdominal diseases. It’s also useful for diagnosing and locating an abscess caused by rupture of the appendix.

When despite the clinical and laboratory investigation and image analysis the doubt remains, laparoscopy may be indicated. This is performed by introducing a small telescope into the abdomen coupled with a microcamera that transmits images to a TV monitor. With laparoscopy, the appendix can be viewed, and one can diagnose its inflammation and resulting complications, and even remove the diseased appendix or drain the abscess secondary to appendicitis.

How is it treated?

When there’s suspicion of acute appendicitis, surgery is indicated, which is carried out with general anesthesia. The operation is performed with a surgical incision in the right lower abdomen, and the diseased organ is removed. When an abscess is also present, draining is performed.

Currently, the operation can be performed by laparoscopy, in which the operative procedure is the same, the difference being that the abdominal incision is quite smaller.

The hospitalization time for non-complicated acute appendicitis usually is short, lasting as long as 2-3 days. When an abscess is present, hospitalization is longer. In the event of diffuse peritonitis, fortunately rare, treatment will be well more complex, and there may be life risk and much longer hospitalization time.