One in seven Americans suffered it. Appendicitis. What is it? Part 2 by Aleksandr Kavokin, MD/PhD

The position of the appendix may vary. If it is longer than normal, appendix may go deep down into the pelvis. It also may move behind the colon (called a retro-caecal appendix). From one hand it is better because retro-caecal appendix has less chances to burst into peritoneal cavity, from the other it is difficult to diagnose and it is difficult to approach surgically. Inflammation of other organs, for example, female pelvic organs, may resemble inflammation of the appendix. Pregnant women may have appendix pushed up in abdomen by the enlarged uterus. Athletic young adults may tolerate more pain and may have not so obvious symptoms of appendicitis. Old patients may have vague symptoms as well.

Other inflammatory problems may mimic appendicitis. Surgeons often observe patients with suspected appendicitis for a period of time to see if the problem will resolve or suggest appendicitis more strongly versus another condition. Conditions that mimic appendicitis are:

1) Meckel's diverticulitis. 2) Pelvic inflammatory disease -infection of tube and ovary. It is treated with antibiotics alone 3) Fluids from the right upper abdomen may drip into the lower abdomen and cause inflammation resembling appendicitis. Then, for example, patient has gallbladder disease or liver abscess, but all symptoms suggest acute appendicitis. 4) Diverticulitis that occur on the right side. 5) Inflammation of right kidney. 6) Crohn's disease or ulcerative colitis 7) Yersinia enterocolitica infection - the bacteria that comes form certain food - like unpasteurized milk. - may cause appendicitis 8) passing kidney stone 9) ectopic pregnancy 10) ovarian cyst rupture. And so on. There are some other conditions.

Appendectomy is performed urgently usually. Thomeo is Latin for dissect or cut. Lapar - is abdomen (belly) in medical Latin. Laparotomy is opening of belly. Appendectomy is cutting of appendix. Laparoscopy is looking (by scope) into belly. Antibiotics almost always are given prior to surgery as soon as appendicitis is suspected.

Few patients have mild "confined appendicitis" localized to a small area. These patients may improve during several days of observation when treated with antibiotics alone. Doctors may or may not removed the appendix later. Chances are you are not one of this patients.

If a person has not seen doctor for many days while appendicitis ruptured (yeah, sometime happens; there are some tough guys), an abscess may form, and the perforation may close. Initially it can be treated with antibiotics; however, that will require drainage later. A drain is guided under ultrasound or CT scan and appendix is removed after the abscess resolves.

In modern days surgeons offer laparoscopic appendectomy. They insert laparoscope (it is like a small telescope with a video camera) and remove appendix with special instruments through small puncture wounds.

If you had this type of surgery, you will probably have four 1-cm size scars and you will go home in one or two days.

But if your case is complicated or there is just no laparoscopy in the hospital, they will do classical appendectomy. Surgeon cuts 10-cm incision in the area of the appendix. Appendix is removed form the right lower abdomen or where it is. Area is checked for other problems. In the case of abscess the purulent stuff will be drained with rubber tubes through the skin. With that kind of surgery you will probably stay for four to seven days. Antibiotics will help to resolve the abscess.

This is why you sign the consent: "laparoscopic appendectomy, possible conversion to an open appendectomy".

The most common complication of appendectomy is wound infection. If it is severe, the surgeon will postpone incision closure for several days.

Ok, now you have those four small scars or one big scar, you go home and visit that party that you missed.

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BIO:

Aleksandr Kavokin, MD1994 Russia,PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U of South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://www.geocities.com/aging_rejuvenation/ http://www.appendicitis.uni.cc/, http://www.geocities.com/appendicitis_disease/

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