Appendicitis

Although most people think of pain from appendicitis in the lower right side of the abdomen, the pain from appendicitis usually starts around the umbilicus or even above it. The pain then moves to the lower right abdomen. There may also be other symptoms such as nausea, vomiting and fever. There is usually pain when pressing on the abdomen over the area of the appendix, and the muscles will be felt to be tense. Sudden release of the pressure can also cause pain.

Physical examination by palpating and having pain in the abdomen only confirms the presence of inflammation and/or infection in the lining of the abdominal cavity below the area being pressed. It does not indicate the source of the inflammation or infection.

The most accurate test is a CT scan. Other tests such as blood tests have been reported to have accuracy as low as 50%.

Appendicitis - in particular acute appendicitis - should be treated immediately as it can lead to serious complications if left untreated. These include:

• Ischemia and Necrosis - Severe swelling in the appendix causes loss of blood supply which eventually leads to tissue death.
• Perforation - A rupture of the appendix wall can allow bacteria, pus, and intestinal contents to spill into the abdominal cavity.
• Abscess Formation - The spilled pus can form a localised abscess around the inflamed appendix.
• Peritonitis - This is a life-threatening inflammation of the peritoneum caused by the spread of bacteria from a ruptured appendix.
• Sepsis - This is a severe infection that can spread throughout the body, potentially leading to organ failure or could even be fatal if not treated.

Almost all cases of appendicitis require the appendix surgery to be removed. There are a few ways to do this:

• Open Surgery - This is the traditional way in which a cut is made across the lower right side of the abdomen and the appendix is removed through the cut. The cut is usually at least 4-5 cm long and can be even longer if there is severe infection around the appendix.
• Laparoscopic (Keyhole) Surgery - This is quite common nowadays. A cut is made at the umbilicus and a camera is inserted. Two small 5mm cuts are made further below to put in the instruments to free up the appendix and cut it off. The appendix is then removed through the cut at the umbilicus.
• Single Port Surgery - This is a variation of laparoscopic surgery in which a special device is inserted at the umbilicus. All the instruments are placed through the device, thus avoiding the other two small 5mm cuts. The surgery is performed in the same way as the standard laparoscopic surgery.