Content

Introduction

Introduction

"Appendicitis is a" sudden and rapid (acute) inflammation of the appendix, a thin, elongated pouch-shaped organ located on the right side of the belly, at the bottom. 5 to 10 centimeters long, the appendix originates from the initial part of the intestinal tract called colon (in particular, from the called party blind) and is rich in lymphatic tissue.

Appendicitis is a frequent disease at any age, in both men and women, although it occurs mainly between the ages of 6 and 30. It is rarely found in children under 4 years of age.

Inflammation of the appendix is ​​often a consequence of the obstruction of its internal cavity (the so-called lamp) which determines the stagnation of mucus and bacteria normally present and the formation of pus. In the absence of rapid medical intervention, the appendix can puncture and spread pus and feces inside the abdomen, causing an abscess or the fearful peritonitis, ie the spread of the infection to the membrane that lines the abdominal cavity and organs.

Thus, appendicitis represents a "medical emergency." The cure, in most cases, consists of "surgery to remove the appendix.

Symptoms

Symptoms

The disorders (symptoms) caused by appendicitis can be different and more or less evident depending on the position and size of the appendix. The most frequent and characteristic ones include:

  • abdominal pain or cramps, at first mild, within 24 hours they become stronger and stronger. They also increase in intensity with movement, deep breathing, palpation, coughing or sneezing
    Pain can be localized:
    • initially, around the navel or at the level of the stomach and, subsequently, as it becomes more intense and continuous, in the right part of the abdomen, at the bottom (site of the appendix)
    • directly in the lower right area of ​​the abdomen
    • throughout the abdomen in the case of rupture of the appendix (peritonitis)
  • nausea and vomit
  • pain in the right leg
  • loss of appetite
  • mild fever (up to 38 degrees) in the initial forms and without peritonitis (in the latter case the fever exceeds 38 degrees)
  • general malaise
  • constipation or diarrhea
  • inability to expel intestinal gas
  • abdominal bloating
  • high number of white blood cells (leukocytosis) evidenced by the "execution of a blood test, the blood count

If disorders attributable to appendicitis appear, it is essential to go to the doctor quickly to understand what causes them and to avoid, in case they are due to the "inflammation of the appendix, which can rupture causing peritonitis. This can also occur within a period of 12- 24 hours.

Causes

Causes

The main cause of appendicitis is the presence of material trapped inside the small cavity inside the appendix. It is mostly thick mucus, small stools (coprolites), intestinal parasites (in children, the presence of pinworms), food residues or other foreign bodies. These substances, therefore, not being able to escape from the appendix, over time cause the multiplication of bacteria, the formation of pus, the swelling and redness of the walls and the decrease in flow of blood to the tissues.

All this can increase the risk of rupture or perforation of the appendix and the consequent passage of feces and pus in the abdomen causing a peritonitis, ie the spread of the infection to the membrane that lines the abdominal cavity and organs. In some cases, the pus remains localized near the appendix and the so-called appendicular abscess.

Diagnosis

Diagnosis

In general, appendicitis can be easily ascertained (diagnosed) starting from the appearance of the first painful disorders (symptoms), from the general state of health and from a thorough medical examination. During the visit, the doctor examines the abdomen and checks whether by pressing at the site of the appendix (lower right part of the abdomen) the pain worsens. Then he asks specific questions about the appearance of the disorders and their type and, if he deems it necessary, prescribes a blood test, the blood count , and instrumental investigations such as ultrasound and, albeit more rarely, CT. The blood count is useful for checking the number of white blood cells which, in the case of appendicitis, is considerably higher than normal values. Ultrasound and CT scan confirm the presence of appendix inflammation. Abdominal CT scan is used mainly in obese people or to clarify doubts.

Disorders (symptoms) similar to those typical of appendicitis can also appear in the case of other diseases such as, for example, gastroenteritis (if diarrhea is present), urinary tract infections, diseases of the ovaries and tubes, ectopic pregnancy in women, intestinal blockage, constipation. Consequently, to identify the cause of the disturbances, urinalysis may also be prescribed, to rule out a urinary infection or, in the case of women of childbearing age, a pregnancy test for be sure it is not an extra-uterine pregnancy.

Crohn's disease can also cause similar ailments but, in this case, they last over time (chronic) and are often accompanied by weight loss and diarrhea.

Therapy

Therapy

The choice of the most suitable treatment (therapy) for appendicitis depends a lot on some factors such as the general state of health, age, previous illnesses, the possible danger of rupture of the appendix with consequent risk of peritonitis.

The most frequent treatment (therapy), to prevent the appendix from breaking, consists in its surgical removal (surgical intervention of appendectomy). Since the appendix does not perform any indispensable function in the organism, its absence does not cause problems.

If you suspect that you have an inflamed appendix it is advisable not to drink or eat in order to be ready for any surgery. Also, you should not take painkillers, sedatives or antibiotics because they could mask the signs of its presence. If pain appears. located to the right of the abdomen, at the bottom, and after a few hours they do not decrease, even if you are fasting or going to the body, it is advisable to immediately contact the attending physician, or the emergency room, to verify the cause. Quickly ascertain the inflamed appendix it allows to intervene and to avoid that it can rupture, spreading the infection in the abdomen and causing peritonitis (inflammation of the membrane that lines the abdominal cavity and organs).

The appendix removal surgery can be performed in two ways:

  • minimally invasive surgery (laparoscopy), an operation that involves three or four small incisions on the right side of the abdomen to insert a micro-camera and special precision surgical instruments capable of removing the appendix. This type of operation allows a rather fast physical recovery and a quick return home
  • open surgery with the traditional method (laparotomy), an operation that consists of a single cut in the lower right part of the abdomen. This type of surgery requires a longer stay in hospital and, sometimes, the application of a small drain (a tube) in the abdominal cavity to allow pus, or other fluids, to escape thus avoiding the danger of an infection. There open surgery it is practiced in case of perforated appendix, of peritonitis or abscess

Both interventions include general anesthesia and, at times, the removal of sutures and laboratory analysis of the appendix taken. This serves to check for inflammation, for a possible pinworm infestation (Enterobius vermicularis) and to rule out cancers (carcinoids) or other diseases such as Crohn's disease.

In any case, appendectomy is a decisive and rather common operation, without particular or serious post-operative complications. However, like all surgeries, it has some risks. They include:

  • wound infection, even if taking antibiotics greatly decreases the possibility that it can occur
  • bleeding under the skin, resulting in the formation of a lump (hematoma) that usually gets better on its own as the days go by
  • scars, more or less evident depending on the type of surgery performed

A possible alternative to emergency surgery, in the event that doctors decide not to operate immediately, can be represented by antibiotic therapy and the use of an ice pack. However, surgery remains the only resolutive type of therapy.

Prevention

Prevention

A varied and balanced diet, a "diet with the right fiber content, a healthy lifestyle, maintaining a correct body weight and carrying out regular and frequent physical activity, can certainly help prevent the risk of numerous diseases." including appendicitis. Furthermore, a good, slow and careful chewing of food, helping to facilitate digestion, can help to maintain a good functioning of the intestine and, therefore, to avoid the appearance of some problems, including constipation, which could favor the formation of small hard stools (coprolites) often responsible for blocking the appendix.

Complications

Complications

If not treated in time, appendicitis can lead to serious complications which include:

  • peritonitis, occurs when the appendix, now swollen and inflamed as a result of the obstruction of its internal cavity, breaks, spreading the infection and the bacteria inside the abdomen (peritoneal sac). The fever rises above 38-39 degrees and heartbeat and breathing become accelerated. If you do not intervene quickly (within a few hours) by removing the appendix with surgery (appendectomy), your health conditions worsen to become very serious and life-threatening
  • abscess, painful collection of pus that forms around a perforated appendix. It represents the body's attempt to fight the infection in progress, circumscribing the pus with fibrous bundles (adhesions) that attach themselves to nearby organs. The abscess can be cured with the use of antibiotics, although at times it may be necessary to get the infected fluids out through a surgical drainage performed under local anesthesia.
Living with

Living with

If you suspect that you have appendicitis it is very important that you do not try to reduce pain by taking pain relievers or sedatives while waiting for medical intervention as they may mask the signs of inflammation making it more difficult for the doctor to discover the cause.

Furthermore, it is advisable to avoid eating and drinking while waiting to be seen by the doctor since, in most cases, urgent surgery will be required if it is an appendicitis.

In the period following the operation, it is necessary to avoid bathing or showering until the wound is well closed. Furthermore, it is advisable to wait 3 to 4 weeks before being able to cautiously and gradually resume physical activity In some cases, it may be necessary to take antibiotics or undergo specific medications.

From a dietary point of view, liquid foods such as broth, fruit or vegetable juices, herbal teas will be preferred.Instead, it will be good to avoid foods that produce gas such as legumes or aged cheeses.

Useful tips

Useful tips

Following the surgical removal of the appendix (especially in the case of peritonitis) it is useful to follow a period of rest in order to allow the body time to get back into shape before being able to resume (gradually and with caution) the activities of all days.

In the 24-72 hours following surgery, you will not have to drink or eat; hydration will take place intravenously. Only after this period it will be possible to gradually start again first to drink then to eat.

To prevent infection of the wound, it will be necessary to medicate it regularly and avoid getting it wet before it is well healed. The doctor will also decide how much and whether to prolong antibiotic therapy.

Bibliography

Bibliography

Bambino Gesù Children's Hospital. Acute appendicitis

Italian Auxological Institute - IRCCS. Appendicitis

Humanitas Research Hospital. Appendicitis

Agostino Gemelli University Hospital Foundation - IRCCS. Appendicitis 3.0: here's how to diagnose and treat it

Mayo Clinic. Appendicitis (English)

NHS. Appendicitis (English)

National Institutes of Health (NIH). National Institute of Diabetes and Digestive and Kidney Diseases Appendicitis (English)

In-depth link

In-depth link

Umberto Veronesi Foundation. Magazine. Appendicitis: when antibiotics are enough and when surgery is needed

Corriere della Sera. Dictionary of Health. Chronic appendicitis

Jones MW, Lopez RA, Deppen JG. Appendicitis.StatPearls. [Internet]. September 9, 2021

Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: efficient diagnosis and management.American Family Physician. 2018; 98: 25-33 

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